scholarly journals Bedside single burr hole craniostomy drainage of chronic subdural hematoma in the emergency room: A useful option in resource challenged settings

2020 ◽  
Vol 11 ◽  
pp. 349
Author(s):  
Toyin Ayofe Oyemolade ◽  
Augustine Abiodun Adeolu
Keyword(s):  
Subdural Hematoma ◽  
Standard Treatment ◽  
Negative Impact ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Emergency Unit ◽  
Emergency Ward ◽  
Neurological Condition ◽  
Accident And Emergency ◽  
Neurological Conditions

Background: In resource challenged environments, the standard treatment of chronic subdural hematoma (CSDH) in the theater may be delayed because of the endemic financial constraint and logistic problems with consequent negative impact on the outcome. An emergency bedside burr hole craniostomy with a local anesthetic at the accident and emergency ward may be lifesaving in patients presenting in extreme neurological conditions in these settings. Case Description: We presented three patients (one male and two females) with CSDH who presented at our service in poor neurological condition. The patients were between 49 and 70 years. The Glasgow Coma Score ranged from 3 to 6. The three patients had respiratory and pupillary abnormalities at presentation. They all had bedside single frontal burr hole craniostomy drainage of the hematoma under local anesthesia at the accident and emergency unit of the hospital. Surgery was done within 1 h of review by the neurosurgical team in all cases. The duration of hospital stay ranged from 8 to 24 days. The outcome was good in all cases. Conclusion: Bedside single burr hole craniostomy at the accident and emergency unit may be lifesaving in patients with CSDH who present in extreme neurological condition but in whom prompt standard surgical treatment in the theater is not feasible.

scholarly journals International practice variation in postoperative imaging of chronic subdural hematoma patients

2019 ◽  
Vol 131 (6) ◽  
pp. 1912-1919 ◽  
Author(s):  
Alexander F. C. Hulsbergen ◽  
Sandra C. Yan ◽  
Brittany M. Stopa ◽  
Aislyn DiRisio ◽  
Joeky T. Senders ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Subdural Hematoma ◽  
Medical Center ◽  
Chronic Subdural Hematoma ◽  
Ct Scanning ◽  
Burr Hole ◽  
Ct Scans ◽  
Neurological Condition ◽  
Asymptomatic Patients ◽  
Significant Difference

OBJECTIVEThe value of CT scanning after burr hole surgery in chronic subdural hematoma (CSDH) patients is unclear, and practice differs between countries. At the Brigham and Women’s Hospital (BWH) in Boston, Massachusetts, neurosurgeons frequently order routine postoperative CT scans, while the University Medical Center Utrecht (UMCU) in the Netherlands does not have this policy. The aim of this study was to compare the use of postoperative CT scans in CSDH patients between these hospitals and to evaluate whether there are differences in clinical outcomes.METHODSThe authors collected data from both centers for 391 age- and sex-matched CSDH patients treated with burr hole surgery between January 1, 2002, and July 1, 2016, and compared the number of postoperative scans up to 6 weeks after surgery, the need for re-intervention, and postoperative neurological condition.RESULTSBWH patients were postoperatively scanned a median of 4 times (interquartile range [IQR] 2–5), whereas UMCU patients underwent a median of 0 scans (IQR 0–1, p < 0.001). There was no significant difference in the number of re-operations (20 in the BWH vs 27 in the UMCU, p = 0.34). All re-interventions were preceded by clinical decline and no recurrences were detected on scans performed on asymptomatic patients. Patients’ neurological condition was not worse in the UMCU than in the BWH (p = 0.43).CONCLUSIONSWhile BWH patients underwent more scans than UMCU patients, there were no differences in clinical outcomes. The results of this study suggest that there is little benefit to routine scanning in asymptomatic patients who have undergone surgical treatment of uncomplicated CSDH and highlight opportunities to make practice more efficient.

Modified Burr-Hole Craniostomy for the Treatment of Chronic Subdural Hematoma in Adults

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Zhiyong Zhao ◽  
Jinglong Zhang ◽  
Guojin Zhang ◽  
Yuntai Cao ◽  
Gang Wang ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Burr Hole

scholarly journals A Rare Complication of Chronic Subdural Hematoma Evacuation: Brain Stem Hemorrhage: A Case Report

2018 ◽  
Vol 32 (3) ◽  
pp. 462-465 ◽  
Author(s):  
Ghassen Gader ◽  
Mouna Rkhami ◽  
Maher Ben Salem ◽  
Mohamed Badri ◽  
Kamel Bahri ◽  
...  
Keyword(s):  
Brain Stem ◽  
Subdural Hematoma ◽  
Rare Complication ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Burr Hole ◽  
Sudden Increase ◽  
Vascular Disruption ◽  
Rapid Decompression ◽  
Surgical Modality

Abstract Chronic subdural hematoma (CSDH), which commonly affects the elderly, is one of the most frequent, but also benign neurosurgical pathologies. Burr hole drainage is the standard surgical modality for evacuation of a CSDH. This technique is known to be safe, with low morbidity and mortality rates. However, postoperative complications have occasionally been reported. We report the case of a 70-year-old man who presented a fatal brain stem hemorrhage after burr-hole drainage for unilateral chronic subdural hematoma. Asymmetrical and rapid decompression were thought to be leading to vascular disruption or sudden increase in cerebral blood flow, was probably responsible for the secondary brain stem bleeding. Therefore, a slow rate of evacuation of chronic subdural hematomas, as well as rigorous postoperative reanimation, are recommended in order to prevent serious complications.

Chronic Subdural Hematomas: To Drain or Not to Drain?

Neurosurgery ◽  
1985 ◽  
Vol 16 (2) ◽  
pp. 185-188 ◽  
Author(s):  
Thomas Marc Markwalder ◽  
Rolf W. Seiler
Keyword(s):  
Clinical Improvement ◽  
Closed System ◽  
Subdural Hematoma ◽  
Drainage System ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Postoperative Phase ◽  
Consecutive Series ◽  
Neurological Improvement ◽  
Burr Hole Evacuation

Abstract A consecutive series of 21 adult patients with chronic subdural hematoma was studied in respect to postoperative resolution of subdural collections and clinical improvement after burr hole evacuation without subdural drainage. This series was compared to a previously studied series of patients with chronic subdural hematoma in whom postoperative closed system drainage had been installed. Using the identical protocol for treatment and postoperative follow-up, we obtained identical results with respect to time-related neurological improvement and persistence of subdural collections in the undrained and drained series, except that the steadily progressive clinical improvement during the early postoperative phase (24 hours) in all cases of the drained series was not universal in the undrained cases. Our study suggests that, to avoid the possibility of early postoperative clinical deterioration, burr hole craniostomy and closed system drainage is advisable. We think that subdural drainage is not necessary when the installation of the drainage system seems to be technically difficult, as it may be in cases with considerable perioperative cortical expansion.

Endoscope-assisted single burr hole drainage and irrigation of chronic subdural hematoma (SDH): A retrospective analysis

2016 ◽  
Vol 30 (2) ◽  
pp. 103 ◽  
Author(s):  
Vyas Khongbantabam ◽  
KhaidemMani Singh ◽  
Supriya Laifangbam ◽  
TakhellambamArun Singh
Keyword(s):  
Retrospective Analysis ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Burr Hole

Predicting Functional Impairment in patients with chronic subdural hematoma treated with burr hole Trepanation—The FIT-score

2019 ◽  
Vol 182 ◽  
pp. 142-147 ◽  
Author(s):  
Nicolai Maldaner ◽  
Marketa Sosnova ◽  
Johannes Sarnthein ◽  
Oliver Bozinov ◽  
Luca Regli ◽  
...  
Keyword(s):  
Functional Impairment ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Burr Hole
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