Burr Hole Drainage Research Articles

High Blood Pressure and Obesity in Children Aged 5 to 12 Years (P.E.M.H)

Background: Chronic Subdural Hematoma (C.S.D.H.) is familiar with the collection of blood on the brain's surface, and in everyday neurological practices, it is the most ordinary clinical entity. This leads to the commendatory prognosis of infection. Surgical therapy is linked with numerous complications because of patients' medical problems and advanced generations. C.S.D.H. is commonly not being out symptoms, but it requisite surgical approaches when it occurs. C.S.D.H. has very well diagnosis and treatment approaches that are most effective, but some essential factors that lead to this disease are still unknown. This study is to know about the surgical outcome. Method: Out of 80 C.S.D.H. Patients between 60 to 70 years were selected.50 male and 30 female C.S.D.H. patients were treated with one burr hole and catheter drainage. The study was conducted at the neurosurgery unit of MartbaChuhan Medical College and Mardan Medical Complex from April 2018 to March 2021. A total of 80 patients were included in this study. Burhhole and Cather Drainage were performed for all patients. These patients were reviewed after 2, 5, and 6 weeks at O.P.D. Results: Mostly the patients, 94% show a good recovery, and 4% represent no recovery. However, only 2% show the complications against this approach. As for the burr hole and catheter drainage, there was a remarkable reduction of the C.S.D.H. However, 5% of the sample patients show the repetition of Hematoma after the 1 week of operation. In contrast, 2% suffered from some operative complications. Conclusion: Burr hole and Catheter drainage is an affected way of treatment for the patients suffering from C.D.S.H.

Association between postoperative pneumocephalus and chronic subdural hematoma recurrence: A single-center population-based study in Puerto Rico

BackgroundChronic subdural hematomas (CSDHs) are common conditions in neurosurgery, and their recurrence rate after initial surgery is high. Many studies have attempted to use radiographic features to predict recurrence, including postoperative pneumocephalus. However, to our knowledge, no study has directly measured the volume of pneumocephalus and its association with CSDH recurrence at the population-based level. MethodsA single-center Puerto Rican population-based retrospective review was performed on patients surgically treated for CSDH from July 2017 to December 2019. The volume of postoperative pneumocephalus was measured using open-source imaging software. Univariate and multivariate analyses were used to compare recurrence and nonrecurrence groups. ResultsA total of 108 patients were included in the study: 42 patients (39%) with recurrence and 66 patients (61%) without recurrence. The median postoperative pneumocephalus volume was 7.0 cm3 (Q1-Q3: 2.3–23.6). After the univariate analysis, sex, size of subdural space, postoperative midline shift, and volume of postoperative pneumocephalus differed significantly between recurrence and nonrecurrence groups (p ≤ 0.04). Multivariate logistic regression analysis showed that the volume of postoperative pneumocephalus was the only independent variable associated with CSDH recurrence (p = 0.01). ConclusionsPostoperative pneumocephalus is common after the evacuation of a CSDH. In our sample population, postoperative pneumocephalus volume was the only independent variable that differed between recurrence and nonrecurrence patients. Our results indicate that for every cubic centimeter of air introduced into the cranial cavity after burr-hole drainage, the risk of CSDH recurrence increases by 4%.

Factors Associated with Outcomes in Patients with Chronic Subdural Hematoma who Underwent 'Burr Hole Craniotomy'.

Chronic subdural hematomas (CSDH) is frequently encountered in neurosurgical practice. The aim of this study was to investigate the factors associated with the outcome of Burr Hole Craniotomy. This study was conducted on 116 patients with CSDH in Be'sat Hospital, an educational hospital, in Kurdistan province, Iran. We used Glasgow outcome scale (GOS) at times of discharge and 1 month after stitch removal as favorable outcome. Student t-test or corresponding nonparametric test (Mann-Whitney U test) and logistic regression were used to assess the relationship between investigated variables and favorable outcome. : The results indicated that the chance of success after surgery in patients with CSDH was different based on several variables. The chance of cure after surgery among CSDH male patients (OR = 12.5), patients who have no atrophy (OR = 25.0), patients with no cardiovascular diseases (OR = 7.14), patients who had no medical complications after surgery (OR = 2.08), and patients with higher GCS score at the time of hospitalization (OR = 1.31) was higher. Burr hole drainage technique is a simplified, efficient and reliable method of treating patients with CSDH. Our study highlights various factors including female gender, diffuse brain atrophy, postoperative medical complications, a previous history of cardiovascular disease, and lower GCS score at the time of admission can be related to patients' worse outcome.

Obesity Paradox and Surgical Evacuation for Chronic Subdural Hematoma.

Background: Chronic subdural hematoma (cSDH) has a number of risk factors for recurrence, and some studies suggest obesity is one of them. Yet obesity has been shown to have a positive survival benefit in many diseases such as ischemic stroke, chronic obstructive pulmonary disease, percutaneous coronary intervention, and mechanical thrombectomy. Therefore, we sought to determine if obesity provided a mortality benefit in patients with cSDH undergoing burr hole drainage or craniotomy.Methods: We performed a retrospective database analysis using a multi-institutional (TriNetX) database looking at obese versus non-obese patients with cSDH undergoing surgical drainage. Our primary endpoint was mortality. Secondary endpoints included seizure, pulmonary embolism (PE), myocardial infarction (MI), cerebral infarction, deep vein thrombosis (DVT), tracheostomy, and percutaneous endoscopic gastrostomy (PEG). These were looked at to obtain a better idea of prognosis. Cohorts were propensity score-matched for confounders, using the greedy-nearest neighbor algorithm with a caliper of 0.1 pooled standard deviations. Kaplan-Meier survival curves were also developed, and hazard ratios were calculated. Chi-square analysis was performed on categorical variables.Results: A total of 1,849 patients were identified as obese with a drainage procedure, while 12,371 were identified as non-obese. Some 1,746 patients remained in each group after propensity score matching. Thirty-day survival rates were 88.08% in the obese vs. 83.82% in the non-obese cohorts, 90-day survival 85.15% vs. 79.35%, 365-day survival at 80.89% vs. 71.90%, and five-year survival at 64.75% vs. 54.84% (p < 0.0001). The risk difference was -8.02% (95% confidence interval, Cl -11.02, -5.021%); relative risk, RR 0.757, 95% Cl (0.67, 0.841); odds ratio, OR 0.676 (0.583, 0.783); p < 0.0001). Seizures, ventilator dependence, MI, cerebral infarction, tracheostomy, and PEG rates were all non-significant. Obese patients had a higher rate of PE (7.90% vs. 4.47%, p < 0.0001) and DVTs (12.37% vs. 10.02%, p = 0.0278).Conclusions: Obesity in patients with cSDH undergoing surgical evacuation is associated with decreased mortality but higher rates of DVT and PE.

Neurosurgical Treatment of Patients with Posterior Fossa Acute Subdural Hematoma Right after Cardiac Surgery.

As posterior fossa acute subdural hematoma (ASDH) right after cardiac surgery is extremely rare, the clinical course and optimal treatment strategy remain undetermined. We performed a retrospective analysis of patients with posterior fossa ASDH right after cardiac surgery requiring neurosurgical treatment at our institution over a 7-year period and, in this study, discussed the neurosurgical strategy and clinical course. Collected data included clinical history, laboratory results, time course, symptoms, neurosurgical treatment, outcome at discharge, and imaging studies. All six patients were women who had no history of head trauma and had received antithrombotic therapy during the perioperative period of cardiac surgery. All patients showed lower platelets count and were diagnosed with ASDH within 3 days (longest time 64 h) right after cardiac surgery. After discontinuation of anticoagulation therapy and administration of reversal agents, they underwent emergency hematoma evacuation craniotomy (n = 5) or burr hole drainage surgery (n = 1), which were performed in the prone (n = 4) or lateral (n = 2) positions. Four of these patients showed favorable outcomes, and two showed poor outcomes. One of the poor-outcome patients received three antithrombotic therapies, and another developed rapidly progressive ASDH. Posterior fossa ASDH associated with antithrombotic therapy right after cardiac surgery is frequently found in women, and emergent neurosurgical treatment with anticoagulation discontinuation and reversal agent administration can be performed safely. Burr hole drainage surgery might be acceptable in nonsevere cases. By contrast, we must pay attention to cases receiving both anticoagulant and antiplatelet drugs and rapid progression cases.

Abstract No.: ABS0857: Efficacy and Safety of Mini-craniotomy under Local Anaesthesia as a Less Invasive Procedure for Chronic Subdural Hematoma

Background & Aims:Background: Mini-craniotomy is generally considered a better technique than burr hole drainage for chronic subdural haematoma (CSDH) as there are less chances of recurrence and need for re-surgery . But generally mini craniotomy is performed under general anaesthesia and this is found to be associated with post-operative complication in earlier studies. The same procedure when carried under local anaesthesia is expected to cause less post-operative complicationsParameterGroup 1 (GDT) (n=32)Group 2 (CHT) (n=32)P*Total intraoperative fluid input2567.81±534.67492670.62±698.75890.511Total intraoperative blood loss496.87±221.044512.50±216.64590.776Total intraoperative urine output558.59±353.1316466.56±243.83500.230Haematocrit Baseline30.59±6.150630.08±4.44220.705 End of surgery27.07±4.767527.14±4.68710.958 Δ Haematocrit3.73±5.20673.02±4.76940.572 P#0.0000.000Lactate Baseline2.00±1.46201.64±1.11760.284 End of surgery1.65±1.27661.57±0.96950.777 Δ Lactate0.35±0.49180.06±0.70790.069 P#0.0000.000Total ventilator days3.21±4.75594.50±4.75190.300Total ICU days2.00±4.99623.37±6.07340.346Total hospital days6.50±6.44347.46±6.79170.575GCS at discharge$10.26±4.0846 9.56±4.38400.538GOS at 3 months post discharge^4.21±1.31564.00±1.58670.644Methods:In this retrospective study patients of age 50 years or higher those who underwentmini-craniotomy under general or local anaesthesia were included. Preoperative condition, surgery duration and post-operative complications were obtained from patients’ medical records and comparedResults:Sixty patients were included in the study. Thirty-two of these patients underwent mini-craniotomy under LA and thirty-eight under GA. Improvement was better in patients who underwent the surgery under local anaesthesia than the general anaesthesia group. Postoperative complications like pneumonia and DVT (Deep Venous Thrombosis) were less frequent in local anaesthesia group.Conclusion:Mini-craniotomy performed under local anaesthesia is found to have same efficacy than the same procedure performed under general anaesthesia. It is also found to have less chances of recurrence, reoperation and postoperative complication. So, mini-craniotomy under local anaesthesia can be better alternative for CSDH.

Using a Carpenter’s Square to Localize Narrow or Multilayered Chronic Subdural Hematomas Diagnosed on Computed Tomography

Chronic subdural hematomas (CSDHs) with narrow or multilayered hematomas must be accurately localized for burr hole drainage. We present a simple alternative localization method using conventional computed tomography (CT) scans acquired for the initial diagnosis and a commercially available carpenter's square (CS). Using our novel method, we localized 77 narrow or multilayered CSDHs. A single burr hole site on the thickest portion of narrow hematomas or on the site allowing access to both the isolated superficial layer and the deep layer of multilayered hematomas was identified on axial CT images; the image was parallel to the orbitomeatal line (OML). On the target CT slice, the level from the OML and from the surface of the forehead to the intended burr hole (sagittal distance) was measured. The OML and the level of the CT target slice were marked using the CS. Then, the CS was placed at the marked target level; the 2 edges of the CS were situated on the frontal and temporal scalp and parallel to the OML and the sagittal line. The sagittal distance was then marked. All burr holes reached the CSDHs. The mean deviation of the burr holes was 4.7 mm inferior and 1.4 mm anterior to the intended site. In 65 instances (84.4%), a deviation within 10 mm was observed in both the superoinferior and the anteroposterior directions. Our simple and inexpensive method can localize narrow or multilayered CSDHs with acceptable accuracy and increases the efficiency of routine clinical work.

Epidemiology of surgically managed traumatic brain injury patients

Traumatic brain injury (TBI) constitutes a major health and socioeconomic problem throughout the world TBI is called the ‘silent epidemic’ because problems resulting from TBI are often not immediately visible and TBI patients are not very vociferous. Epidemiological studies of TBI are essential to the targeted prevention and effective treatment of brain-injured patients. Epidemiology analysis of surgically managed traumatic brain injury patients was done. Mean age was 35.9 years. Males were more commonly (80%) involved than females (20%). In 57.5% of cases, falls were responsible for TBI and in 42.5% of cases, Road traffic accidents were responsible. Edh was the most common type of TBI in (50%). Chronic SDH occurred in 25% of cases. Acute SDH and Contusions were both seen in 13.75% of cases. Depressed fractures occurred in 6.25% of cases and ICH occurred in 1.25% of cases. Craniotomy was the most common (42%) surgical procedure performed, followed by burrhole drainage (22.5%). Decompressive craniectomy was done in 18.75% of cases and elevation of depressed fracture was performed in 6.25% of cases. Traumatic brain injury (TBI) constitutes a major health and socioeconomic problem throughout the world. People of all ages are affected by it. Males are more commonly involved as compared to females. Timely hospitalisation and surgical management whenever indicated improves the survival.

Clinical and Radiologic Outcomes of Single Burr Hole Drainage and Minicraniotomy in the Treatment of Inhomogeneous Chronic Subdural Hematoma: A Retrospective Study.

The optimal treatment for inhomogeneous chronic subdural hematoma (CSH) remains unclear. This study thus aimed to compare single burr hole drainage with minicraniotomy in the treatment of inhomogeneous CSH, including complication and recurrence rates. The clinical and radiologic data of 240 patients with inhomogeneous CSH who underwent surgery between January 2005 and January 2021 were retrieved. A total of 111 patients were included in this study. Clinical and radiological outcomes were compared between the groups undergoing different surgery types. A total of 102 (91.8%) patients showed clinical improvement after surgery; 81 (93.1%) and 21 (87.5%) patients showed improvements in clinical symptoms in the single burr hole and minicraniotomy groups, respectively. A total of 102 (91.9%) patients showed favorable radiological findings after the surgery, including inhomogeneous CSH disappearance in 64 (73.6%) burr hole and 13 (54.2%) minicraniotomy patients, and inhomogeneous CSH improvement in 17 (19.5%) burr hole and 8 (33.3%) minicraniotomy patients. There were no significant differences in the patient characteristics or surgical outcomes between the groups. Single burr hole drainage showed a slightly better improvement in clinical and radiologic findings and lower recurrence and complication rates than minicraniotomy. There were no statistically significant differences between the two groups.

Factors Influencing Outcome and Mortality of Brain Abscess in Mosul City

Background: Brain abscess by definition is a crucial pus collection inside the brain, resulted from the infection by a variety of bacteria, fungi, and parasite. It can be single or multiple. The size, position, and number of lesions, as well as the organism's pathogenicity, host reactions, and the severity of cerebral edema, all influence the presentation. Objective: To assess how well a brain abscess was managed and to evaluate the patients with favorable and unfavorable Glasgow outcome scale (GOS). Patients and methods: From January 2014 to January 2021, the study was achieved and conducted in the Neurosurgical Department of Ibn-Sina Teaching Hospital on Mosul's left coast. The neurosurgery unit managed a case series investigation of 70 patients who had a brain abscess. Age, sex, duration of illness, initial neurosurgical status, and abscess features are among the clinical data. A comparison was performed between patient with Favorable Glasgow outcome scale (GOS), moderate disability or those with good recovery and those with Unfavorable GOS, death or persist vegetate status outcome at discharge. Results: The study involved 48 male and 22 female patients (male / female ratios 2.2:1). The series consist of 52 patients who experienced favorable outcome and 18 resulted from an unfavorable outcome. The mean of age for those patients was 20 years. The difference between males and females regarding favorable and unfavorable outcomes is insignificant. P-value was significant in cyanotic congenital heart diseases as cause of brain abscess were particularly prevalent among the children (adult VS children = 1:9). The most common site for single abscesses was the frontal lobe (25 patients), and majority of patients treated with burr hole drainage, which had the best results. Conclusion: Although there were technological improvement of imaging and antibiotics treatment, the mortality of brain abscesses is still relatively high, especially among those with decreased level of consciousness on admission.

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

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.

Middle Meningeal Artery Embolization for the Treatment of Bilateral Chronic Subdural Hematoma.

Background: Bilateral chronic subdural hematoma (bCSDH) is a frequent condition commonly linked to the need for retreatment; however, the reason for this high retreatment rate remains unclear. The middle meningeal artery (MMA) was found to have a relationship with the occurrence and development of chronic subdural hematomas. This study examines a possible method to reduce bCSDH recurrence using bilateral MMA embolization combined with bilateral burr-hole drainage.Materials and Methods: Ten patients with bCSDH who underwent bilateral MMA embolization combined with bilateral burr-hole drainage at our hospital between June 2018 and May 2020, were retrospectively analyzed. Patients' clinical information, prognoses, imaging results, as well as surgical results were documented and analyzed.Results: Ten patients were diagnosed with bCSDH with no comorbid brain diseases. They underwent bilateral MMA embolization combined with bilateral burr-hole drainage. We embolized the MMA immediately before burr hole drainage successfully and employed angiography to validate these results. All the patients attained relief of symptoms without adverse events, and no re-expansion or relapse was reported in the follow-up computed tomography.Conclusion: Bilateral MMA embolization combined with bilateral burr-hole drainage is an available treatment for patients with bCSDH and may have the potential for preventing recurrence.

Twist drill craniostomy vs burr hole drainage of chronic subdural hematoma: a systematic review and meta-analysis.

There is a clinical equipoise between burr hole drainage (BHD) or twist drill craniotomy (TDC) as initial surgical intervention in patients with chronic subdural hematoma (cSDH). Moreover, the impact of type of postoperative drainage is not well elucidated. We performed a systematic review and meta-analysis comparing outcomes following BHD and TDC for initial surgical management in cSDH and to understand the impact of negative suction drainage with TDC. A literature search was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies that directly compared TDC and BHD. The following outcomes were compared between TDC and BHD: mortality, recurrence, reoperations, complications, and cure rates. Subgroup analysis was performed to determine impact of negative suction drainage with TDC. Sixteen articles (n = 1,235; TDC: 663; BHD: 591) met inclusion criteria. Although complications (OR: 0.68, 95% CI: 0.38-1.23, p = 0.21; I2 = 31%), recurrence (OR: 1.16, 95% CI: 0.84-1.62, p = 0.37; I2 = 28%), cure (OR: 1.11, 95% CI: 0.72-1.72, p = 0.64, I2 = 34%), and mortality rates (OR: 1.20, 95% CI: 0.60-2.41; p = 0.61; I2 = 0%) were not significantly different between the two groups, TDC was associated with a higher reoperations than BHD (OR: 1.48, 95% CI:1.01-2.16, p = 0.04; I2 = 41%). Subgroup analysis demonstrated that TDC with negative suction drainage conferred equivalent reoperation rates as BHD (OR: 0.75, 95% CI: 0.24-2.35; p = 0.62; I2 = 65%); however, TDC without negative suction was associated with higher reoperations (OR: 1.62, 95% CI: 1.08-2.42; p = 0.02; I2 = 40%). A systematic review and meta-analysis of available literature directly comparing TDC and BHD for primary evacuation of cSDH did not demonstrate clear superiority of either technique, although reoperations may be higher following TDC. Use of negative suction drainage with TDC may lead to similar rates of reoperation as BHD.

Chronic Subdural Hematoma Drainage Under Local Anesthesia with Sedation versus General Anesthesia and Its Outcome

Burr hole drainage is the criterion standard treatment for chronic subdural hematoma (CSDH), a common neurosurgical condition. However, apart from the surgical technique, the method of anesthesia also has a significant impact on postoperative patient outcome. Currently, there are limited studies comparing the use of local anesthesia with sedation (LA sedation) versus general anesthesia (GA) in the drainage of CSDH. The objective of this study was to compare the morbidity and mortality outcomes of using LA sedation versus GA in CSDH burr hole drainage. This retrospective study presents a total of 257 operations in 243 patients from 2 hospitals. A total of 130 cases were operated under LA sedation in hospital 1 and 127 cases under GA in hospital 2. Patient demographics and presenting features were similar at baseline. Values are shown as LA sedation versus GA. Postoperatively, most patients recovered well in both groups with Glasgow Outcome Scale scores of 4-5 (96.2% vs. 88.2%, respectively). The postoperative morbidity was significantly increased by an odds ratio of 5.44 in the GA group compared with the LA sedation group (P= 0.005). The mortality was also significantly higher in the GA group (n= 5, 3.9%) than the LA sedation group (n= 0, 0.0%; P= 0.028). The CSDH recurrence rate was 4.6% in the LA sedation group versus 6.3% in the GA group. No intraoperative conversion from LA sedation to GA was reported. This study demonstrates that CSDH drainage under LA sedation is safe and efficacious, with a significantly lower risk of postoperative mortality and morbidity when compared with GA.

Contralateral subdural effusion after decompressive craniectomy: What is the optimal treatment?

ObjectiveContralateral subdural effusion after decompressive craniectomy (CSEDC) is rare, and the optimal treatment is not determined. We present 11 cases of CSEDC and give an overview of the English literature pertaining to this disease. MethodsWe searched the database at our institution and performed a search of English literature in PubMed and Google Scholar. Keywords used were as follows (single word or combination): “subdural hygroma”; “subdural effusion”; “decompressive craniectomy”. Only patients with CSEDC and contained adequate clinical information pertinent to the analysis were included. Results11 cases of CSEDC were recorded at our institution. They comprised ten men and one woman with an average age of 41.9 years. All the 8 symptomatic patients underwent surgery and the CSEDC resolved gradually. 68 cases of CSEDC were found in the literature. Including ours, a total of 79 patients were analyzed. Conservative treatment was effective in the asymptomatic patients. 41.7% of the symptomatic CSEDC underwent burr hole drainage and successfully drained the CSEDC. However, 76% of them received subsequent surgery to manage the reaccumulation of CSEDC. 25% of the symptomatic patients underwent cranioplasty, while 13.3% of them received Ommaya drainage later because of CSEDC recurrence. 18.3% of the symptomatic patients underwent cranioplasty plus subduroperitoneal shunting, and all CSEDC resolved completely. ConclusionsBurr hole drainage appears to be only a temporary measure. Early cranioplasty should be performed for patients with CSEDC. CSF shunting procedures may be required for patients in whom CSEDC have not been solved or hydrocephalus manifest after cranioplasty.

Warning with chronic subdural hematomas in the elderly

Chronic subdural hematoma (cSDH) is a disorder in which blood collects between the dura and arachnoid mater of meninges around the brain. It's more common among the elderly and usually triggered by a head injury. We report a case of a 78-year-old male patient who had previously been diagnosed with a left hemisphere subdural hematoma for no apparent reason with a history of hypertension. Two days before hospitalizing, he had a symptom of weakness in the right extremities. Non-contrast CT of head reveals a crescent-shaped, heterodense lesion over the lateral aspect of the left hemisphere measuring 11x5x1 cm with mass effect to the adjacent brain parenchyma. Burr hole drainage was performed for the patient. His symptoms improved after the surgery.

P-OT023. Intracranial subdural empyema mimicking acute on chronic subdural hematoma: a case report

Introduction. Intracranial subdural empyema is a rare localized intracranial infection that forms between dura and arachnoid membrane of the meninges. Its unspecific clinical presentations as well as neuroimaging findings that might resemble subdural hematoma make the definitive diagnosis of subdural empyema difficult. This report aims to highlight the importance of making a differential diagnosis of subdural empyema in a suspected case of subdural hematoma. Results. A 71 years old male presented with acute mild to moderate intermittent headache that was followed by sudden difficulty in word findings and right limbs weakness. No history of fever, trauma, seizure, or prior history of ear, nose, throat, tooth infections, and intracranial surgical procedure. Increased white blood cells count was not found despite the increased neutrophil to lymphocyte ratio as well as C-reactive protein. Non-contrast head CT-scan showed crescentic hyperdense lesion within a wider hypodense lesion in the left frontotemporoparietal region, characterizing acute on chronic subdural hematoma. During burr hole drainage, pus was found, consistent with subdural empyema. An intralesion antibiotic treatment was given after complete removal of the pus. Conclusion. Intracranial subdural hematoma and subdural empyema with the involvement of neurological deficits are emergency conditions. However, it is difficult to differentiate these two conditions even after the examinations of clinical, laboratory, and neuroimaging with non- contrast head CT-scan, particularly without the triad of subdural empyema: fever, headache, vomiting. Our case showed that even without noticeable port d’entry, intracranial subdural empyema could be formed.

Single versus double burr holes evacuation in the treatment of chronic subdural hematoma

Background: Chronic subdural hematoma (CSDH) is a well-known entity and common surgical disorder managed by the neurosurgeon and, if not recognized and treated timely, may prove fatal. It can be non-traumatic or post-traumatic and all of them need urgent attention irrespective of aetiology. It manifests with a progressive neurologic deficit that occurs &gt;3 weeks following head injury. The principal techniques used in the treatment of CSDHs presently are burr hole, twist drill craniostomy, craniectomy and craniotomy. Objective: The aim of this study was to assess clinical outcome in unilateral chronic subdural hematoma patients treated by single or double burr-hole drainage. This prospective study was carried out at the Department of Neurosurgery, IMS, BHU, Varanasi from September 2016 to August 2018. A total of 60 patients with their age ranged from 22to 88 years with GCS 6 to 15 &amp; hematoma thickness 10mmc were included in this study and randomly divided into two groups using random allocation software. In group A, patients with chronic subdural hematoma (CSDH) were managed with single burr-hole drainage. In group B, patients were managed with double burr-hole drainage. Clinical outcome was measured on the1st postoperative day, 3rd postoperative day and 7th postoperative day by GCS and at 1month follow-up by measuring the Glasgow outcome scale (GOS). Result: In this study double burr-hole drainage and single burr-hole drainage surgery shows equal success in the management of CSDHs with single burr hole taking less operative time.

The Mini-Craniotomy for cSDH Revisited: New Perspectives.

Background: Chronic subdural hematomas (cSDH) are increasingly prevalent worldwide with the increased aging population and anticoagulant use. Different surgical, medical, and endovascular treatments have had varying success rates. Primary neurosurgical interventions include burr hole drainage of the cSDH and mini-craniotomies/craniotomies with or without fenestration of the inner membrane. A key assessment of the success or failure of cSDH treatments has been symptomatic recurrence rates which have historically ranged from 5 to 30%. Pre-operative prediction of the inner subdural membrane by CT scan was used to guide our decision to perform mini-craniotomies. Release of the inner membrane facilitates the expansion of the brain and likely improves glymphatic flow.Methods: Consecutive mini-craniotomies (N = 34) for cSDH evacuation performed by a single neurosurgeon at a quaternary academic medical center/Level I trauma center from July 2018-September 2020 were retrospectively reviewed. Patient characteristics [age, gender, presenting GCS, GOS, initial CTs noting the inner subdural membrane, midline shift (MLS), cSDH width, inner membrane fenestration, cSDH recurrence, post-operative seizures, infections, length of stay] were extracted from the EMR.Results: Twenty nine patients had mini-craniotomies as primary treatment of the cSDH. Mean age = 68.9 ± 19.7 years (range 22–102), mean pre-operative GCS = 14.5 ± 1.1, mean MLS = 6.75 ± 4.2 mm, and mean maximum thickness of cSDH = 17.7 ± 6.0 mm. Twenty four were unilateral, five bilateral, 34 total craniotomies were performed. Thirty three had inner membrane signs on pre-operative head CTs and an inner subdural membrane was fenestrated in all cases except for the one craniotomy that didn't show these characteristic CT findings. Mean operating time = 79.5 ± 26.0 min. Radiographic and clinical improvement occurred in all patients. Mean improvement in MLS = 3.85 ± 2.69. There were no symptomatic recurrences, re-operations, surgical site infections, or deaths during the 6 months of follow-up. One patient was treated for post-operative seizures with AEDs for 6 months.Conclusion: Pre-operative CT scans demonstrating inner subdural membranes may guide one to target the treatment to allow release of this tension band. Mini-craniotomy with careful fenestration of the inner membrane is very effective for this. Brain re-expansion and re-establishment of normal brain interstitial flow may be important in long term outcomes with cSDH and may be related to the recent interests in brain glymphatics and dural lymphatics.

Incidence of chronic subdural haematoma in different age groups and its surgical management

Background: Chronic SDH is a condition which usually affects the elderly population. Trauma is the most common cause of chronic subdural haematoma. Surgical Treatment of chronic subdural haematoma includes burr holes with or without drainage. In patients with membrane formation, craniotomy is considered. Aims: To know the incidence of chronic subdural haematoma in different age groups, the risk factors for its occurrence and its surgical management. Settings and Design: The incidence of chronic SDH in different age groups and the different surgical procedures done for its management were noted. Materials and Methods: Fifty patients of chronic SDH who underwent surgical intervention were analysed. Statistical analysis: Statistical evaluation was done Results: Mean age was 62.06 years. 54% of patients were in the age group of >62 years. Mostly (56%) chronic subdural haematoma was on the right side. Right side chronic subdural haematoma patients had mean age of 60.8 years, left side chronic subdural haematoma patients had mean age of 56.7 years and bilateral chronic subdural haematoma patients had mean age of 75.6 years. Trauma (46%) was most commonly associated with chronic SDH formation. Burr hole evacuation was the preferred surgical treatment modality (92%). Conclusion: Chronic SDH usually occurs in elderly population. Bilateral Chronic SDH is commonly seen in elderly patients. Traumatic brain injury is the commonest predisposing factor for its occurrence. In some elderly patients even a trivial injury may lead to the occurrence of chronic SDH. Keywords: Chronic subdural haematoma, Burr hole drainage, Age related incidence, Bilateral chronic SDH.