Implementation of irrigating drainage systems after burr hole evacuation of bilateral subdural hematomas leads to reduction in postoperative pneumocephalus and improved brain re-expansion – a case report

Abstract Background Symptomatic chronic subdural hematomas (CSDH) remain one of the most encountered forms of intracranial hemorrhages particularly in the elder patients, yet fortunately implies a good surgical prognosis. Burr hole evacuation under general anesthesia is the most commonly used neurosurgical technique for the management of CSDH. Clinical disagreement between many studies regarding the number of burr holes required to achieve the optimal surgical and clinical outcome has long existed. The objective of this study is to evaluate the prognosis and clinical outcome following the use of single-burr hole craniostomy technique in the aim of surgical evacuation of CSDH. Results This is a retrospective study of 30 patients, with symptomatic unilateral or bilateral CSDH managed by the authors strictly by single-burr hole evacuation with closed-system drainage on the corresponding site of the hematoma. Clinical outcome was then assessed at 1, 7, and 30 days after surgery using the Glasgow Coma Scale (GCS) and by comparing the Markwalder grade scale before surgery to 1 month following surgery; the pre- and post-operative radiological data, clinical neurological progress and the possible incidence of complications postoperatively were also recorded. Study duration was from August 2019 to October 2020. Our study included 18 (60%) male patients and 12 (40%) female patients. The main presenting symptom was altered level of consciousness noted in 29 (96.7%) patients; a history of a relevant head trauma was recorded in 11 patients (36.7%). The GCS showed a statistically highly significant improvement comparing the preoperative to the postoperative values throughout the follow-up intervals (p = 0.001); similarly, the Markwalder score significantly improved 1 month after surgery, where 17 (63%) patients were Markwalder grade 0, 9(33.3%) patients were grade 1, a single patient (3.7%) was grade 2, and none were Markwalder grade 3. Conclusion Our study concluded that single-burr hole craniostomy with closed-system drainage for the management of symptomatic CSDH would be a sufficient approach to achieve a good surgical outcome with a low complication rate. Larger series and further studies would be yet considered with longer follow-up periods.

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Which should be appropriate surgical treatment for subtentorial epidural empyema? Burr-hole evacuation versus decompressive craniectomy: Review of the literature with a case report

Asian Journal of Neurosurgery ◽

10.4103/1793-5482.175630 ◽

2016 ◽

Vol 11 (2) ◽

pp. 81

Author(s):

Vaner Köksal ◽

Abdulkadir Özgür ◽

Suat Terzi

Keyword(s):

Case Report ◽

Surgical Treatment ◽

Decompressive Craniectomy ◽

Burr Hole ◽

Review Of The Literature ◽

Burr Hole Evacuation

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The number of burr holes and use of a drain do not interfere with surgical results of chronic subdural hematomas

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20170136 ◽

2017 ◽

Vol 75 (11) ◽

pp. 809-812 ◽

Cited By ~ 8

Author(s):

Lindolfo Carlos Heringer ◽

Ulysses de Oliveira Sousa ◽

Matheus Fernandes de Oliveira ◽

Aline Silva Nunes ◽

Katiusa de Abreu Alves ◽

...

Keyword(s):

Retrospective Review ◽

Burr Hole ◽

Surgical Results ◽

Subdural Hematomas ◽

Burr Hole Evacuation ◽

Burr Holes

ABSTRACT Burr hole evacuation has been the most frequently-used procedure for the treatment of chronic subdural hematomas (CSDH). Objective: To evaluate whether the use of a drain and/or the number of burr holes for treatment of CSDH modifies the rates of recurrence and complications. Methods: A retrospective review of 142 patients operated on because of CSDH, between 2006 and 2015, analyzing recurrence and complications of the use of one or two burr holes with or without the use of a drain. Results: Thirty-seven patients had bilateral CSDH (26%) and 105 (73.9%) patients had unilateral CSDH. Twenty-two (59.4%) patients were given a drain and 15 (40.6%) were not. A total number of recurrences occurred in 22 (15.5%) patients and the total number of complications was in six (4.2%) patients. Mean follow-up time was 7.67 months. Conclusions: The number of burr holes and the use of the drain did not alter the rates of recurrence and complications in the treatment of CSDH.

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Reduction in the number of repeated operations for the treatment of subacute and chronic subdural hematomas by placement of subdural drains

Journal of Neurosurgery ◽

10.3171/jns.2003.99.1.0044 ◽

2003 ◽

Vol 99 (1) ◽

pp. 44-46 ◽

Cited By ~ 99

Author(s):

Christopher R. P. Lind ◽

Christina J. Lind ◽

Edward W. Mee

Keyword(s):

Demographic Data ◽

Burr Hole ◽

Content Type ◽

Subdural Hematomas ◽

Subdural Drain ◽

Burr Hole Evacuation ◽

Brain Expansion ◽

Burr Holes ◽

Fine Print ◽

Auckland Hospital

Object. The aim of this study was to determine the influence of closed-system subdural drainage on repeated operation rates after burr hole evacuation of subacute and chronic subdural hematomas (SDHs). Methods. Five hundred consecutive operations for the treatment of SDH via burr holes were performed between January 1, 1996, and April 15, 2002, at the Auckland Hospital. Hospital records were used to ascertain demographic data, operation, and repeated operation details. Rates of repeated surgeries were compared in patients with and without subdural drains. Repeated operations were performed less frequently in patients with subdural drains, occurring in 31 (10%) of 310 cases involving drains and in 35 (19%) of 188 cases without drains (p < 0.01). Demographics between the two groups were not significantly different except for mean patient age, which was higher among patients with a subdural drain. A lower rate of repeated operation was observed in patients who had undergone drain placement, regardless of whether there was visible evidence of brain reexpansion. Conclusions. Patients have lower rates of repeated surgeries if subdural drains are placed following evacuation of an SDH via a burr hole. To reach high clinical significance, 12 patients must undergo this simple intervention. If technically feasible, subdural drains should be inserted regardless of any occurrence of brain expansion during surgery.

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