Burr Hole Craniotomy Research Articles

Opening the Internal Hematoma Membrane Does Not Alter the Recurrence Rate of Chronic Subdural Hematomas: A Prospective Randomized Trial

Factors determining the recurrence of chronic subdural hematomas (CSDHs) are not clear. Whether opening the so-called internal hematoma membrane is useful has not been investigated. To investigate whether splitting the inner hematoma membrane influences the recurrence rate in patients undergoing burr-hole craniotomy for CSDH. Fifty-two awake patients undergoing surgery for 57 CSDHs were prospectively randomized to either partial opening of the inner hematoma membrane (group A) or not (group B) after enlarged burr-hole craniotomy and hematoma evacuation. Drainage was left in situ for several days postoperatively. Groups were comparable with regard to demographic, clinical, and imaging variables. Outcome was assessed after 3-6 weeks for the combined outcome variable of reoperation or residual hematoma of one third or more of the original hematoma thickness. Fourteen patients underwent reoperation for clinical deterioration or residual hematoma during follow-up (n= 6 in group A, 21%; n= 8 in group B, 28 %) (P=0.537). Residual hematoma of ≥ one third not requiring surgery was present in 7 patients in group A (25%) and 10 patients in group B (36%) (P= 0.383). The overall cumulative failure rate (reoperation or hematoma thickness ≥ one third) was 13/28 (46%) in group A and 18/28 in group B (P= 0.178; relative risk, 0.722 [95% confidence interval, 0.445-1.172]; absolute risk reduction -16% [95% confidence interval, -38% to 8%]). Opening the internal hematoma membrane does not alter the rate of patients requiring revision surgery and the number of patients showing a marked residual hematoma 6 weeks after evacuation of a CSDH.

Contralateral Delayed Acute Subdural Hematoma Following Evacuation of a Chronic Subdural Hematoma with Burr-Hole Craniotomy and Continuous Closed System Drainage: Case Report and Literature Review

Chronic subdural hematoma (CSDH) is a relatively frequent problem in neurologic or neurosurgical practice [1]. The potential for recovery from the evacuation of a CSDH is relatively high. However, some postoperative complications may affect the postoperative course [2]. In this study, we report a rare complication of contralateral acute hematoma following the evacuation of a CSDH with burr-hole craniotomy and continuous closed system drainage. Chronic subdural hematoma (CSDH) is a relatively frequent problem in neurologic or neurosurgical practice. Treatments for CSDH are well established and provide positive postoperative outcome; however, some atypical postoperative complications can occur. This study reports a rare complication of delayed contralateral acute hematoma following the evacuation of a chronic subdural hematoma with burr-hole craniotomy and continuous closed system drainage. According to our research, our study is the first to report a delayed contralateral acute subdural hematoma following CSDH surgery.

Management of Orbital Meningiomas and Associated Proptosis

Orbital meningiomas are rare, accounting 1–2% of all meningiomas. These tumors may originate from the intraorbital optic shead or from the meningeal layer of the optic canal. The clinical presentation of these tumors is a progressive visual deficit and proptosis. A prompt diagnosis is important to avoid an irreversible no light perception. We include a series of 5 cases with the diagnosis of orbital meningioma which were treated surgically by unroofing the orbit and the optic canal. Initially we present cadaveric pictures detailing the epidural pretemporal approach and the anatomy of the anterior clinoid process. A pterional incision was done followed by a 3 burr hole craniotomy. A epidural dissection and retraction of the frontal and temporal lobes is done using multiple anclated sutures. The sphenoidal lesser wing is exposed and drilled until the periorbit is unroofed. The superior and lateral walls of the orbital apex are removed. The lateral orbital fissure is opened and the foramen rotundum is seen laterally. The orbito meningeal dural layer is exposed, coagulated and incised to expose the complete anterior clinoid process. The 3 osseous structures that give its stability are: the lesser wing, the optic canal and the optic strut. To do an anterior clinoidectomy it is important to disarticulate these bony architecture. When completed the optic canal is unroofed and clinoidal triangle of the cavernous sinus is exposed. This decompression of the optic nerve may improve the visual function in some cases, or avoid its prompt worsening. The removal of the superior and lateral walls of the orbit improves the proptosis and aesthetic. In our series 60% of the patients had visual function previous to the surgery and 40% of the patients improved the visual it after decompression of the optic canal. These results emphasize the importance of a prompt diagnosis and treatment.

Advances in minimally invasive treatment of hemorrhagic and ischemic stroke.

Advances in minimally invasive treatment of hemorrhagic and ischemic stroke.

Chronic subdural hematoma: Influence of head position (head low/supine) postoperatively on recurrence rate after burr hole craniotomy

Introduction and Objective: Chronic subdural hematoma is the most common traumatic intra-cranial hemorrhage in elderly. It has serious morbidity and mortality, but good surgical prognosis. Burr hole craniotomy is the most common form of treatment for chronic subdural hematoma. However, there have been very few studies to see the postoperative influence of head position (head low/supine) on recurrence of chronic subdural hematoma. The aim of this study is to compare recurrence rates between patients given head low position postoperatively versus supine position after burr hole craniotomy. Materials and Methods: During the period of months from August 2011 to August 2013, 78 patients of chronic subdural hematoma treated with burr hole craniotomy were included. Pre- and post-operative computed tomography scan\magnetic resonance imaging scan were used for radiological evaluation. After surgical intervention, the preference of head position (supine/head low) of the patient was decided by treating neurosurgeon. Head low position was kept for 3 days. Supine position was given for the rest of the patients. All patients were followed-up for at least 1 month after discharge. Results: Of the 78 patients, 16 patients were given head low position, whereas 62 were given supine position. The overall recurrence rate was 7.69% (6 out of 78) in our study. One of 16 patients (6.25%) given head low position recurred, whereas 5 of 62 patients (8.06%) who were given supine position recurred. Statistically (P > 0.05) postoperative recurrence rate in both groups were same. Conclusion: Results of our study indicate that patients who were given head low position had same recurrence rate as those who were given supine position. Hence, postoperatively position of the head does not influence the recurrence rates.

Placement of Deep Brain Electrodes in the Dog Using the Brainsight Frameless Stereotactic System: A Pilot Feasibility Study

BackgroundDeep brain stimulation (DBS) together with concurrent EEG recording has shown promise in the treatment of epilepsy. A novel device is capable of combining these 2 functions and may prove valuable in the treatment of epilepsy in dogs. However, stereotactic implantation of electrodes in dogs has not yet been evaluated.ObjectiveTo evaluate the feasibility and safety of implanting stimulating and recording electrodes in the brain of normal dogs using the Brainsight system and to evaluate the function of a novel DBS and recording device.AnimalsFour male intact Greyhounds, confirmed to be normal by clinical and neurologic examinations and hematology and biochemistry testing.Methods MRI imaging of the brain was performed after attachment of fiducial markers. MRI scans were used to calculate trajectories for electrode placement in the thalamus and hippocampus, which was performed via burr hole craniotomy. Postoperative CT scanning was performed to evaluate electrode location and accuracy of placement was calculated. Serial neurologic examinations were performed to evaluate neurologic deficits and EEG recordings obtained to evaluate the effects of stimulation.ResultsElectrodes were successfully placed in 3 of 4 dogs with a mean accuracy of 4.6 ± 1.5 mm. EEG recordings showed evoked potentials in response to stimulation with a circadian variation in time‐to‐maximal amplitude. No neurologic deficits were seen in any dog.Conclusions and Clinical ImportanceStereotactic placement of electrodes is safe and feasible in the dog. The development of a novel device capable of providing simultaneous neurostimulation and EEG recording potentially represents a major advance in the treatment of epilepsy.

Chronic subdural hematoma in patients under age 65 years: A comparative study of age cohort

Chronic subdural hematoma (CSDH) in patients 65 years old is not uncommon, but its exact situation is not well-clarified. In this study, we compare the clinical variables between two age groups (≤65 years and >65 years), and focus on the characteristics of younger adults. In this 2-year retrospective study, 98 patients with CSDH were enrolled and subdivided into younger (≤65 years) and older (>65 years) groups. Information about presenting symptoms and neuroimages was recorded. We also investigated recurrence, morbidity, mortality, and neurological outcome after burr hole craniotomy. The patients ≤65 years accounted for 29% of the CSDH cases. Younger adults had a lower incidence of hemiparesis than older patients (p = 0.03). Analysis of the computerized tomography (CT) scans on admission revealed differences in layering of the hematoma (p = 0.009) and multiplicity of hematoma cavities (p = 0.001). The recurrence rate was 18% for the younger group and 13% for the older group (p = 0.53). The occurrence of postoperative morbidity and mortality was similar in the two age groups (p > 0.99 and p = 0.56, respectively). An unfavorable Glasgow Outcome Scale was not observed in any of the younger patients, but was seen in six of the older patients; however, there was no statistically significant difference between the age groups (p = 0.18). The clinical presentations and CT features of patients ≤65 years of age varied from those of older patients. Clinicians should note this variability to facilitate proper management.

Contralateral Acute Subdural Hematoma Following Traumatic Acute Subdural Hematoma Evacuation

Contralateral acute subdural hematoma (ASDH) occurring after removal of traumatic ASDH is a rare, but nearly devastating postoperative complication. We treated a 26-year-old male who developed a contralateral ASDH shortly after craniectomy for evacuation of a traumatic ASDH. Burr-hole craniotomy was performed before decompressive craniectomy, and the bleeding source was a cortex artery within the frontal lobe contusion. Despite supportive therapy with barbiturate and mild hypothermia he expired 3 days later of brain death. Literature review suggests that the old are more susceptible to contralateral ASDH following evacuation of traumatic ASDH. Contralateral ASDH following evacuation of traumatic ASDH is a rare but potentially lethal complication, so neurosurgeons should try to detect such contralateral hematoma formation and prevent clinical deterioration.

Routine postoperative CT-scans after burr hole trepanation for chronic subdural hematoma - better before or after drainage removal?

To evaluate timing of scheduled CT-scans after burr hole trepanation for chronic subdural hematoma (cSDH). 131 patients with primary cSDH were included. Scheduled CT-scans were performed after burr hole trepanation and placement of a subdural drain. The influence of CT-scanning with or without indwelling drain was analysed regarding subsequent surgery and CT-scans, duration of hospitalization, short- and middle-term follow up by single factor analyses. Subgroup analyses were performed for patients receiving anticoagulant drugs. Median age was 74 years. Routine CT-scans with indwelling drainage were not shown to be beneficial regarding subsequent burr hole trepanations (p=0.243), craniotomies (p=1.000) and outcome at discharge (p=0.297). Mean duration of hospitalization (11 vs. 8 days, p=0.013) was significantly longer and number of subsequent CT-scans was higher when CT scan was performed with indwelling drain (2.3 vs. 1.4, p=0.001). In middle-term follow-up, beneficial effects of CT-scanning with inlaying drainage could neither be shown. Moreover, advantageous effects of CT-scans with indwelling drains could neither be shown for patients receiving anticoagulant drugs. Scheduled postoperative cranial imaging with indwelling drains was not shown to be beneficial and misses information of intracranial damage inflicted by removal of drains. We thus recommend CT-scanning after drainage removal.

Surgery for contralateral acute epidural hematoma following acute subdural hematoma evacuation: five new cases and a short literature review

The occurrence of a contralateral acute epidural hematoma (AEDH) following removal of an acute subdural hematoma (ASDH) is a rare but nearly devastating postoperative complication. Here, we describe a series of five patients with contralateral AEDH and provide a review of the literature to elucidate the characteristics and improve management of these patients. A total of 386 patients underwent ASDH evacuations in our hospital between August 2008 and July 2011. Five of these patients (1.3%) developed AEDH that required surgery. Thirty-two additional patients were identified by a search of the PubMed database. Clinical features, surgical treatment, and outcomes (scored by Glasgow outcome scale, GOS) of the collective 37 AEDH cases were analyzed retrospectively. Contralateral AEDH after ASDH evacuation occurred in 27 males (73%) and 10 females (27%) (mean age: 35.9 ± 14.2years). Twenty-six patients (70%) had unfavorable outcomes (GOS 1-3), and 11 patients (30%) had favorable outcomes (GOS 4-5). Contralateral skull fractures and intraoperative acute brain swelling occurred in 30 (81%) and 28 (76%) patients, respectively. The preoperative Glasgow coma score (GCS) was significantly associated with outcome (p < 0.05). Lower preoperative GCS score is an independent risk factor for prognosis of contralateral AEDH after ASDH. Postoperative management should include assessment of AEDH in patients treated for contralateral skull fractures and who experienced intraoperative acute brain swelling. We recommend early decompression with a burr-hole craniotomy, immediately followed by a decompressive craniectomy. This strategy provides gradual decompression, while advancing the initial surgical time and preventing the suddle decreased tamponade effect. As such, it may help decrease the risk of contralateral AEDH associated with decompression.

The Subdural Evacuation Port System: Outcomes from a single institution experience and predictors of success

IntroductionNumerous surgical options for treatment of chronic subdural hematomas (cSDH) exist. Several reports have examined the Subdural Evacuating Port System (SEPS), a variation of the twist drill craniotomy (TDC) technique. Although high success rates have been reported, a significant portion of patients treated with SEPS fail and require additional procedures. This report examines the largest single institution experience with the SEPS and explores patient and imaging characteristics associated with successful procedures. MethodsA retrospective chart review was performed to identify all patients who have undergone SEPS drainage of cSDH. Demographic and radiographic characteristics were evaluated. Demographic data included patient's age, sex, presenting symptoms, pre-procedural GCS score, and use of anticoagulation or antiplatelet agents. The volume of drainage per procedure and radiographic data including laterality, density, and maximal diameter of the collection, presence of septations, midline shift, resolution of the collection 3 weeks post procedure, and measurements to assess atrophy were collected. Total length of stay and time in the intensive care unit was also recorded. Results were classified as a success or failure based on the need for additional procedures including craniotomy or burr hole craniotomy in the operating room. Patients treated with two SEPS procedures during the same hospitalization and no other procedures were included in the success group for statistical analyses. Results171 subdural collections were treated in 159 patients (147 unilateral and 12 bilateral). One hundred thirty three collections (77.8%) were successfully drained. In a comparison of the success and failure groups, there were no statistically significant differences (p<0.05) in the patients’ mean age, sex, presenting Glasgow Coma Scale score, coagulation profile, presenting symptoms (except altered mental status and language disturbance), subdural diameter or laterality, midline shift, presence of atrophy, density of most acute portion, or time in hospital. In the success group, there was a shorter mean stay in the intensive care unit (S: 4.1±4.5 days vs F: 5.4±4.6 days; p=0.03) and a larger output drained (S: 131.1±71.2ml vs F: 99.0±84.2ml; p=0.04). Success was less likely with mixed density collections (S: 38.2% vs F: 64.3%; p=0.02) and with collections containing greater than 2 intrahematomal septations (S: 17.1% vs F: 40.7%; p=0.007). In successful cases, mean volumes for collections prior to SEPS, immediately after SEPS, and on delayed scans (≥30 days since SEPS placement) the respective volumes were 83.1±35.1ml, 41.5±23.2ml, and 37.9±26.5ml. Both post-SEPS volumes were less than the pre-SEPS volume (p<0.0001). 76.0% of patients with delayed scans had complete resolution of cSDH or minimal residual cSDH with no local mass effect on the most recent imaging. The mean period of follow-up imaging was 95.6±196.2 days. Only one patient in our series required an emergent craniotomy following immediate complications from SEPS placement. ConclusionsThe SEPS is an effective, safe, and durable treatment for cSDH. Although we consider the SEPS a first-line treatment for the majority of patients with cSDH, management of cSDH must be tailored to each patient. In mixed density collections with large proportions of acute hemorrhage and in collections with numerous intrahematomal septations, alternative surgical techniques should be considered as first-line therapies.

Incidence et impact clinique des crises comitiales périopératoires pour les hématomes sous-duraux chroniques

Background and purposeSeizures can occur in patients who have surgery for a chronic subdural hematoma. However, the incidence of seizures and their impact on the clinical course of patients in the perioperative period is not well known. MethodsIn this retrospective study, we reviewed 161 cases of patients treated for chronic subdural hematoma in our institution. The surgical procedures consisted in trephine craniotomy in 156 cases, burr-hole craniotomy in three cases, and bone flap craniotomy in two cases. All the patients had systematic antiepileptic drug prophylaxis. ResultsIn our patients’ population, the incidence of seizures was 10.6% before surgery and 14.9% after surgery. Low initial score on the Glasgow Coma Scale (P<0.001) and preoperative cognitive impairment (P=0.005) were associated with a higher rate of postoperative seizures. In our study, the mortality rate was 14.9%. Low initial score on the Glasgow Coma Scale (P=0.068) and postoperative seizures (P=0.002) were associated with a higher mortality rate. ConclusionsWe have shown that patients suffering from seizures may have worse outcome. The benefit of a systematic perioperative prophylaxis using antiepileptic drugs has to be evaluated.

Treatment of acute traumatic subdural hematomas in infants

Objective To investigate the clinical features of acute traumatic subdural hematomas (SDH) in infants and discuss the treatment methods. Methods The clinical features of 48 infants under three years old with acute traumatic SDH admitted from 2002 to 2008 were retrospectively analyzed.Results There were 31 infants under one year old (65%). The most popular injury cause was accidental fall in 37 patients (77%). Of all patients, 12 patients (25%) had disturbance of consciousness,eight ( 17% ) had convulsion and eight ( 17% ) were combined with skull fractures. The treatment methods included craniotomy and evacuation of the blood clot in 18 patients ( including 13 patients underwent instant operation after admission ), burr hole craniotomy and external drainage of the chronic subdural hematoma in seven and conservative management in 23 with small subdural hematomas. All patients obtained good outcome except that two patients had motor dysfunction and one death. Conclusions The incidence of acute traumatic SDH in infants is high, especially in infants under one year old. It is easy to be disregarded at early stage and may deteriorate to chronic subdural hematoma or hydropsy. Early diagnosis and active surgical treatment may attain sound prognosis. Key words: Craniocerebral trauma; Hematoma, subdural; Infants

Extracranial Posterior Communicating Artery Bypass for Revascularization of Patients With Common Carotid Artery Occlusion

Extracranial-intracranial bypass surgery provides blood flow augmentation in patients suffering from intracranial or long-distance conductance artery stenosis or occlusion that otherwise cannot be treated. The standard procedure for these cases is an anastomosis between the superficial temporal and middle cerebral arteries. However, in patients presenting with common carotid artery occlusion, the superficial temporal artery is no longer sufficiently perfused. For these patients, alternative revascularization strategies have to be applied. To describe a novel strategy for revascularization of patients with common carotid artery occlusion, ie, the extracranial posterior communicating artery bypass. Two patients with chronic cerebrovascular compromise resulting in transitory ischemic attacks and/or border-zone infarctions caused by common carotid artery occlusion were referred to our institution. A radial artery bypass was established between the third segment of the vertebral artery and an M3 branch of the middle cerebral artery. The vertebral artery was exposed between the vertebral lamina of C1 and occipital bone via a paramedian incision. The bypass was tunneled subcutaneously, conducted intracranially via a tailored extended burr-hole craniotomy, and anastomosed to a recipient M3 vessel. The postoperative course of both patients was uneventful in terms of cerebral ischemia or bleeding complications. In both patients, postoperative angiographic controls revealed an excellent bypass function with markedly improved hemispheric filling of multiple middle cerebral artery branches. The patients were discharged without new neurological symptoms. Our extracranial posterior communicating artery bypass using a radial artery transplant from the vertebral artery to the middle cerebral artery is a useful tool to treat patients suffering from hemodynamic cerebrovascular compromise caused by common carotid artery occlusion.

Burr-hole craniotomy treating chronic subdural hematoma: a report of 398 cases

Objective To investigate the treatment of chronic subdural hematoma (CSDH) with burr-hole craniotomy in our hospital. Methods From January 2004 to December 2009, 398 patients with CSDH, 338 males and 60 females (male/fe male=5.63/1), received burr-hole craniotomy in our hospital. The median age was 60 years with the mean age of (58.1±18.1) years, (65.0±14.5) years for females and (57.0±18.2) years for males. Trauma history w as determined in 275 patients (69.1%). Burr-hole craniotomy was performed under local anesthesia in 368 patients and general anesthesia in 30 patients. CSDH was classified into 3 groups according to the density on CT scan. Clinical data concerning etiologies, symptoms and signs, concomitant diseases, diagnosis, therapies and outcomes were investigated retrospectively. Patients' neurological status on admission and at discharge was also classified to judge the outcomes. Results Generally, trauma history showed few differences between those over 60 years old and under 60 years old, but showed obvious differences when gender was taken into account. Totally 123 male patients (60.0% of 204 cases) suffering from head injuries were under 60 years, whereas 35 female patients (85.4% of 41 cases) with trauma histories were over 60 years. The duration from trauma to appearance of clinical symptoms was (84.0±61.7) days (range, 0-1493 days). Traumatic accident was the leading etiology, other accompanying diseases such as cerebral vascular disease, hypertension, etc, were also predisposing factors. Commonly, the elderly presented with hemiplegia/hemidysesthesia/hemiataxia and the young with headache. Most CSDH patients (95.6%) treated with burr-hole craniotomy successfully recovered. However, postoperative complications occurred in 17 cases, including recurrence of CSDH in 15 cases, subdural abscess in 1 case and pneumonia in 3 cases. Conclusion Burr-hole craniotomy is an easy, efficient and reliable way to treat CSDH.

Twist drill craniostomy with closed drainage for chronic subdural haematoma in the elderly: An effective method

Objective Chronic subdural haematoma is a disease of the elderly and surgery in these patients carries a much higher risk. The common surgical procedures for chronic subdural haematoma include twist drill craniostomy, burr hole evacuation or craniotomy. The aim of this study was to analyse the results of twist drill craniostomy with drainage in elderly patients with chronic subdural haematoma. Methods Forty-two elderly patients (>65 years) with radiologically proven chronic subdural haematoma were analysed. All the patients underwent twist drill craniostomy and continuous drainage of the haematoma under local anaesthesia and total intravenous anaesthesia (TIVA). Results There were 24 males and 18 females. Headache and cognitive decline was seen in 50% and weakness of limbs in 60% of patients. CT scan was done in all cases. All patients underwent twist drill 2–3 cm in front of the parietal eminence under local anaesthesia. The drain was left for 24–72 h depending on the drainage. At 1 week, 88% of patients had a good outcome. Conclusion Twist drill craniostomy with drainage under local anaesthesia is a safe and effective procedure for chronic subdural haematoma in the elderly and could be used as the first and only option in these people.

Outcome of 2 different types of operative techniques practiced for chronic subdural hematoma in Malaysia: an analysis

Background Traumatic chronic subdural hematomas in Malaysia are increasingly common in young patients after road traffic accidents as well as the elderly who fall at home. Most surgeons in this country manage these pathologies without irrigation, with only a drainage system. This has led to criticism that the recurrence rate might be higher when no irrigation is done and that rates are lower with irrigation and drainage. Thus, a study was done to look into the outcome of TCSH operated with and without irrigation, followed by drainage, to guide the surgeons in Malaysia as to what best could be done for these cases. Methods A cross-sectional study was conducted on 2 surgical treatments: burr hole drainage with irrigation and without irrigation based on the internal architecture of chronic subdural hematomas based on CT of the brain and their outcome in relation to their clinical parameters. Results A total of 42 patients treated with the burr hole craniotomy without irrigation with drainage were compared to 40 patients with irrigation and drainage. In both groups, univariate and multivariate analysis revealed that good clinical outcome was associated with preoperative Markwalder grade and the presence of postoperative hematoma recurrence. There was no difference in good outcome between the 2 operative methods. Conclusion There was no significant difference between these 2 operative techniques in relation to outcomes whether good or bad. The recurrence rate was 12.2%. When either technique is done properly, no difference to the outcome is seen. Neurosurgeons or general surgeons in Southeast Asia may choose not to irrigate the chronic subdural space, although drainage placement is necessary afterwards.

Hemorrhagic internal pachymeningitis. A clinical study of 131 cases

Between 1980 and 1985, 131 patients suffering from haemorrhagic internal pachymeningitis had undergone surgery. Mean patient age was 59 years (range: 16-90 years). Operation technique was burr-hole craniotomy with closed-system drainage in 124 cases. In five cases primary, in 24 cases secondary removal of the capsule was performed. An Ommaya reservoir was implanted in eight cases. All patients were re-examined after an average of six months and classified into six groups according to the neurological findings. Comparison of initial findings and final results showed an improvement in the patients' condition in 83 cases (63%). There was no change in 20 patients (15%) and deterioration in seven (5%). Twenty-one patients (16%) died during the observation period.

Outcome of Double burr-hole Craniotomy in patients with Chronic Subdural Haematoma

Background: Chronic subdural haematoma (CSDH) is a common condition in late stages of life. Most of the patients are subjected to minor trivial trauma which will end up with a collection of altered blood in the subdural space. This necessitates immediate surgical drainage, with the aim to reduce the mass effect on the brain to alleviate the symptoms and to reverse the condition. Objective: To report the experience and outcome of double burr-holes craniotomy in treatment of chronic subdudal haematoma. Patents and Methods: This study was conducted on 70 patients with CSDHs managed at Omdurman Teaching Hospital Sudan, during the period from November 2004 to November2006.. All patients after clinical assessment and CT scan of the brain proved to have CSDH. The haematoma was removed surgically by double burr-holes craniotomy, irrigation and close system drainage. Results: The study included 70 patients, 50 males and 20 females. The mean age was 69 years. Computed tomography scan, showed unilateral collection in 60% of patients and bilateral in 40%, only 1.8% showed conning of the brain. Unilateral double burr-hole craniotomy was performed in 60% of the patients, while bilateral was done in 35.7%. In the postoperative follow up 87.1% of the patients showed uneventful recovery. Seven patients developed complications in the form of pneumocephallus or postoperative recurrence. The mortality rate was 2.9%. Conclusion: burr holes craniotomy, irrigation and close system drainage, is effective and favor rapid regression of residual subdural collection and associated with fewer recurrences.

Lumbosacral spinal subdural hematoma following burr hole craniotomy: Case report and literature review

Spinal subdural hematoma is a rare complication of cranial surgery. This study reports a case of postcraniotomy lumbosacral spinal subdural hematoma in the absence of predisposing factors. A review of the literature is also presented.