Burr Hole Surgery for Drainage of Chronic and Subacute Subdural Hematomas: Low Recurrence Rate in a Single Surgeon Cohort.

Orlando De Jesus,Andres E Monserrate

doi:10.7759/cureus.19288

Abstract

Background: A complication after surgical intervention for chronic and subacute subdural hematoma drainage is the recurrence of hematoma, often requiring repeat surgical management. Recurrence rates varied widely across the published series, which may partially be due to different technical strategies used by the surgeons involved in the study. We decided to review our patients with chronic and subacute subdural hematomas that were surgically managed with a burr hole procedure by a single surgeon to compare recurrence rates with the evidence available.Methods: A retrospective review of the medical records was performed on the patients who underwent burr hole surgical intervention to drain a chronic or subacute subdural hematoma between April 1995 and March 2020. All patients were under the care of a single surgeon at an academic institution. Variables analyzed included age, sex, laterality of the hematoma, and recurrence.Results: During the selected timeframe, 610 cases were identified. There were 35 cases of recurrence of the hematoma. The recurrence rate after burr hole drainage was 5.73%.Conclusion: Surgical drainage of chronic and subacute subdural hematoma via burr hole using consistent stepwise management is associated with a relatively low recurrence rate in our single surgeon patient cohort.

Highlights

Chronic subdural hematoma (CSDH) and subacute subdural hematoma (SASDH) are among the most common diagnoses for neurosurgical consultation at our emergency department
A literature review showed that recurrence rates for C/SA-SDH ranged between 0% and 20% [1,2,3,4,5,6,7,8,9,10]
We identified 524 CSDH cases, which were unilateral in 403 patients and bilateral in 121 (23.1%)

Summary

Introduction

Chronic subdural hematoma (CSDH) and subacute subdural hematoma (SASDH) are among the most common diagnoses for neurosurgical consultation at our emergency department In symptomatic patients, both hematomas are primarily managed surgically via burr hole drainage and subdural irrigation. A common complication after surgical intervention for chronic/subacute subdural hematoma (C/SA-SDH) drainage is hematoma recurrence, often requiring repeat surgical management, more extended hospitalization, and sometimes, increased morbidity and mortality. Recurrence rates varied widely across the published series, which may partially be due to different technical strategies used by the surgeons involved in the study. We decided to review our patients with chronic and subacute subdural hematomas that were surgically managed with a burr hole procedure by a single surgeon to compare recurrence rates with the evidence available

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Conclusion