Novel middle meningeal artery-targeted mini-craniotomy incision and technique for treatment of chronic subdural hematoma with membranes/septations – technical note and case series

Objective: Subdural hematomas (SDH) requiring surgery are associated with significant morbidity in elderly patients. We describe a novel technique/incision for minimizing invasiveness and duration, minimizing recurrence by allowing for resection of subdural membranes and coagulation of the middle meningeal artery (MMA), and providing ease of conversion to a larger craniotomy if needed. Methods: This was a retrospective review of patients who underwent the technique between 2020–2024. We examined the incidence of recurrence requiring re-intervention and additionally compared the cost of supplies/implants of the mini-craniotomy against other craniotomies performed for SDH evacuation and MMA embolization. Results: Fifteen patients (mean age 71.8 years) underwent the novel mini-craniotomy for evacuation of mixed-density chronic SDHs. The mean SDH thickness and midline shift was 18.7 and 6.3 mm respectively. All patients had radiologic evidence of subdural membranes preoperatively. No patients developed symptomatic recurrence requiring surgical evacuation. The mean supply/implant cost of the mini-craniotomy was additionally significantly less than the cost of other craniotomies for SDH evacuation. Conclusion: The described mini-craniotomy is safe, effective, utilizes a small incision, allows for MMA coagulation, provides access to coagulate and resect subdural membranes, can easily be turned into a larger trauma-sized craniotomy if necessary, and optimizes wound healing.