Burr Hole Evacuation Research Articles

Letter: Safety and Effectiveness of an Enhanced Recovery Protocol in Patients Undergoing Burr Hole Evacuation for Chronic Subdural Hematoma.

Letter: Safety and Effectiveness of an Enhanced Recovery Protocol in Patients Undergoing Burr Hole Evacuation for Chronic Subdural Hematoma.

In Reply: Safety and Effectiveness of an Enhanced Recovery Protocol in Patients Undergoing Burr-Hole Evacuation for Chronic Subdural Hematoma.

In Reply: Safety and Effectiveness of an Enhanced Recovery Protocol in Patients Undergoing Burr-Hole Evacuation for Chronic Subdural Hematoma.

Traumatic Tension Pneumocephalus with mount Fuji sign and air bubble sign

Introduction: Tension Pneumocephalus is a rare but a life threatening neurosurgical emergency which may need urgent surgical intervention. For diagnosis Brain imaging preferably Brain CT scan is mandatory. Case presentation: We present a rare case case of post traumatic tension Pneumocephalus in 40 years old man who sustained a road traffic accident. Brain CT scan shows Mount Fuji sign and air bubble sign, which are the typical signs of tension Pneumocephalus. Emergency burr-hole evacuation was carried out and after the procedure the patient was followed by control lateral skull X-ray and then discharged after 10 days of hospital Stay with GCS of 15. Conclusion: Tension Pneumocephalus is a clinical diagnosis. History with Brain Imaging can easily diagnose it but invasive surgical intervention may be Mandatory to overcome the problem. Knowledge of risk factors ,radiographic findings and clinical signs/symptoms associated with Tension Pneumocephalus is crucial to its Prompt identification and treatment.

Comparison of Postoperative Seizures Between Burr-Hole Evacuation and Craniotomy in Patients With Nonacute Subdural Hematomas: A Bi-Institutional Propensity Score-Matched Analysis.

Postoperative seizures are a common complication after surgical drainage of nonacute chronic subdural hematomas (SDHs). The literature increasingly supports the use of prophylactic antiepileptic drugs for craniotomy, a procedure that is often associated with larger collections and worse clinical status at admission. This study aimed to compare the incidence of postoperative seizures in patients treated with burr-hole drainage and those treated with craniotomy through propensity score matching (PSM). A retrospective cohort analysis was conducted on patients with surgical drainage of nonacute SDHs (burr-holes and craniotomies) between January 2017 to December 2021 at 2 academic institutions in the United States. PSM was performed by controlling for age, subdural thickness, subacute component, and preoperative Glasgow Coma Scale. Seizure rates and accompanying abnormalities on electroencephalographic tracing were evaluated postmatching. A total of 467 patients with 510 nonacute SDHs underwent 474 procedures, with 242 burr-hole evacuations (51.0%) and 232 craniotomies (49.0%). PSM resulted in 62 matched pairs. After matching, univariate analysis revealed that burr-hole evacuations exhibited lower rates of seizures (1.6% vs 11.3%; P = .03) and abnormal electroencephalographic findings (0.0% vs 4.8%; P = .03) compared with craniotomies. No significant differences were observed in postoperative Glasgow Coma Scale (P = .77) and length of hospital stay (P = .61). Burr-hole evacuation demonstrated significantly lower seizure rates than craniotomy using a propensity score-matched analysis controlling for significant variables.

Technical Nuances in the Perioperative Management of Chronic Subdural Hematoma by Twin Burr Hole Craniostomy: Tips, Tricks, and Tactics

AbstractChronic subdural hematoma (CSDH) remains to be the most common neurosurgical entity usually encountered in the elderly population. With an increasing life expectancy and associated comorbidities, the incidence of CSDH is ever increasing. There is a lack of uniformity among neurosurgeons regarding management of CSDH, but surgical evacuation using twin burr hole craniostomy remains to be the most preferred modality. Other options available are twist drill craniostomy and craniotomy. A conservative approach may be preferred in a thin subdural hematoma with no or minimal neurological deficit or in high operative risk patients. Complications such as pneumocephalus, recollection, or rebleeding may be seen following surgical evacuation of CSDH. Herein we aimed to address the technical nuances associated with twin burr hole evacuation of CSDH to reduce the complications and the overall associated morbidity and mortality.

Delayed Burr Hole Evacuation Compared With Acute Craniotomy for Acute Subdural Hematoma in Older Patients With Low-Energy Trauma.

Background Acute subdural hematomas commonly require emergent surgical decompression by craniotomy. There is currently limited research on alternative surgical strategies in the elderly population. This study investigates delayed surgical intervention for stable patients with low-energy trauma presenting with acute subdural hematomas. Methodology In this retrospective chart review, 45 patients over the age of 55 presenting with acute subdural hematomas with a Glasgow Coma Scale score greater than or equal to 13 in the setting of low-energy trauma were selected. Additionally, includedpatients had a maximal hematoma thickness of >10 mm and/or a midline shift size of >5 mm per the current Brain Trauma Foundations guidelines for surgical intervention of subdural hematomas. The study was performed at a large tertiary care center, with records being examined from 1995 to 2020. Comparison groups were immediate craniotomy (within 24 hours) or delayed burr hole (minimum of 48 hours passing since the initial presentation). Primary outcomes included minor complications, major complications, any complications, and any complications with mortality excluded. There was no significant difference in mortality between the two cohorts. Results The immediate craniotomy group consisted of 16 patients, while the delayed burr hole group consisted of 29 patients. The results demonstrated a statistically significant increase in the incidence of any complication including mortality (relative risk (RR) = 3.17, 95% confidence interval (CI) = 1.71-5.88, p < 0.0001), major complications (RR = 2.33, 95% CI = 1.07-5.07, p = 0.031), and minor complications (RR = 2.42, 95% CI = 1.02-5.74, p = 0.041) in the immediate craniotomy group compared to the delayed burr hole group. Conclusions Our study demonstrates the decreased risk of major and minor complications for delayed burr hole evacuation in stable patients >55 years old presenting with low-energy trauma and subdural hematoma. The results suggest that for this population of patients, it appears to be beneficial to delay surgery if the patient's clinical situation allows.

Efficacy of superficial cervical plexus block in the management of neck pain due to surgical positioning in patients undergoing burr-hole craniotomy for unilateral chronic subdural hematoma under scalp block: A prospective randomized control trial

: Alternatives to general anesthesia technique, pain management of surgical sites have been discussed at length in various studies for burr-hole evacuation in geriatric patients. This is the first study addressing the management of pain that occurs due to extreme contra-lateral side neck rotation to access the surgical site. : This trial was conducted (from January 2021 to January 2022) on 60 patients of age ≥ 18 years with ASA grade I/I/III undergoing unilateral burr hole craniotomy for evacuation of chronic subdural hematoma (CSDH) under scalp block. Group D (n=30) received 5 ml of 0.5% bupivacaine by ultrasound-guided superficial cervical plexus block (SCPB), and group P (n=30) received SCPB with placebo (normal saline). The primary outcome was the numerical rating pain score (NRS) pain score during neck movement in the postoperative period. Secondary objectives were muscle spasm assessed by the modified Ashworth scale (MAS), consumption dosage of rescue analgesia, modified Ramsay sedation score (MRSS), and hemodynamic parameters.: NRS scores were significantly lower at 8 hours in the SCPB with drug (D) group compared to the SCPB with placebo group (p-value = 0.019). MAS were higher in group P compared to group D until 12 (&amp;#60;0.001). Consumption of rescue analgesia was higher in group P than group D (&amp;#60;0.001). MRSS was significantly higher in group D compared to group P throughout the intra-operative period (&amp;#60;0.001).: Preoperative superficial cervical plexus block decreases postoperative neck pain and facilitates neck rotation.

Mini-Craniotomy for Chronic Subdural Hematoma: A Reliable Surgical Option.

Introduction Chronic subdural hematoma (SDH) is one of the most common conditions encountered in the neurosurgical practice. Surgical modalities like twist drill craniostomy, burr hole evacuation, mini-craniotomy, and craniotomy are practiced in the management of chronic SDH. Mini-craniotomy without excision of membranes may help to achieve best results with decreased complication rate. Materials and Methods Patients with chronic SDH operated from September 2013 to September 2022 were included in the study. Mini-craniotomy (40-60 mm) was done and cruciate incision was given over the dura. Dura was left wide open by reflecting and suturing the cut edges of the dural leaflets to the craniotomy edge allowing to evacuate subdural space under vision during surgery and to allow any residual collection to drain out freely in the postoperative period. A drain was placed between the inner membrane and the bone flap. Preoperative and postoperative clinical and radiological parameters were recorded. Complications, recurrence, and residual collections were noted. Results Seventy-seven patients were included in the study. Mean age was 57.32 years. Median Glasgow Coma Scale (GCS) at presentation was 13 while median GCS at discharge was 15. Two patients with preexisting comorbidities expired after surgery due to medical causes. No recurrences were noted. Fourteen patients had residual collections which resolved by 6 weeks. Two patients had wound infection. One of these patients later needed a bone flap removal due to osteomyelitis. Conclusion Mini-craniotomy without membranectomy is a good option for complete evacuation of chronic SDH under vision mainly avoiding the complication of membranectomy. It is not associated with increased complications rate. It needs fewer follow-ups as brain expansion can be established radiologically in a short period.

Quantitative Assessment of Brain Expansion After Evacuation of Chronic Subdural Hematoma as a Predictor of Recurrence

A lack of brain expansion is considered a risk factor for recurrence after evacuation of a chronic subdural hematoma (CSDH). To the best of our knowledge, no studies have reported on objective measurement of brain expansion after evacuation of a CSDH. We performed a retrospective analysis of prospectively collected data of patients undergoing 2 burr hole evacuation of a CSDH. We measured the depth of the brain surface from the frontal burr hole dural opening after hematoma evacuation using a specially devised measuring tool. Other predictors analyzed for recurrence of hematoma were age, gender, a history of hypertension, the use of anticoagulant and/or antiplatelet agents, Glasgow coma scale score at presentation, unilateral or bilateral hematoma, computed tomography appearance, and hematoma thickness. Among 88 patients who underwent hematoma evacuation, 3 (3.4%) underwent surgery for recurrence. The significant factors associated with recurrence were the presence of bilateral hematoma (P= 0.001), hematoma width >2.3 cm (P= 0.04), gradation type of hematoma on the computed tomography scan (P= 0.03), and the depth of the brain after hematoma evacuation (P= 0.02). The brain expanded less in those with recurrence, with a mean depth of the brain of 18 ± 6 mm versus 7.27 ± 7.8 mm in those without recurrence. Evacuation of a CSDH through 2 burr holes, along with copious irrigation and bed rest for 3 days, resulted in a very low recurrence rate without the use of a drain. A lack of brain expansion might be a predictor of recurrence. To the best of our knowledge, this is the first study to quantitatively measure the depth of the brain at surgery in patients undergoing surgery for CSDH.

Clinical Outcomes in Elderly Patients with Chronic Subdural Hematoma: Validation of Irrigation Assignment Based on Hematoma Characteristics.

The number of elderly patients with chronic subdural hematomas (CSDH) is increasing worldwide; however, there is limited data regarding the clinical outcomes in this population. Our therapeutic method using burr hole evacuation for CSDH is based on the hematoma characteristics, using simple drainage for single-layer lesions and drainage with irrigation for multiple-layer lesions. This study aimed to compare the postoperative outcomes of elderly and younger patients, identify the predictors of outcomes in elderly patients, and verify the validity of our therapeutic methods. In total, we included 214 patients who underwent burr hole evacuation between April 2018 and March 2022. Baseline characteristics, hematoma characteristics, recurrence, and clinical outcomes were compared between the elderly and younger patients. Overall, 96 elderly patients (44.9%) were included in the study, and more elderly patients underwent antithrombotic therapy than younger patients (33.3% vs. 19.5%, p = 0.027). Moreover, elderly patients had significantly fewer favorable outcomes than younger patients (70.8% vs. 91.5%; p < 0.001); however, this was not significant after adjusting for the baseline modified Rankin Scale (mRS). Similarly, elderly patients had higher recurrence rates than younger patients (10.4% vs. 2.5%; p = 0.021). However, the baseline mRS score was the only predictor of unfavorable outcomes. In conclusion, although the clinical outcomes of elderly patients were comparable to those of younger patients, the higher rate of preoperative antithrombotic therapy in elderly patients may result in a higher rate of recurrence requiring a long-term follow-up.

Middle meningeal artery patency after surgical evacuation for chronic subdural hematoma.

Chronic subdural hematoma (CSDH) often requires surgical evacuation, but recurrence rates remain high. Middle meningeal artery (MMA) embolization (MMAE) has been proposed as an alternative or adjunct treatment. There is concern that prior surgery might limit patency, access, penetration, and efficacy of MMAE, such that some recent trials excluded patients with prior craniotomy. However, the impact of prior open surgery on MMA patency has not been studied. A retrospective analysis was conducted on patients who underwent MMAE for cSDH (2019-2022), after prior surgical evacuation or not. MMA patency was assessed using a six-point grading scale. Of the 109 MMAEs (84 patients, median age 72 years, 20.2% females), 58.7% were upfront MMAEs, while 41.3% were after prior surgery (20 craniotomies, 25 burr holes). Median hematoma thickness was 14mm and midline shift 3mm. Hematoma thickness reduction, surgical rescue, and functional outcome did not differ between MMAE subgroups and were not affected by MMA patency or total area of craniotomy or burr-holes. MMA patency was reduced in the craniotomy group only, specifically in the distal portion of the anterior division (p = 0.005), and correlated with craniotomy area (p < 0.001). MMA remains relatively patent after burr-hole evacuation of cSDH, while craniotomy typically only affects the frontal-distal division. However, MMA patency, evacuation method, and total area do not affect outcomes. These findings support the use of MMAE regardless of prior surgery and may influence future trial inclusion/exclusion criteria. Further studies are needed to optimize the timing and techniques for MMAE in cSDH management.

Results of Comparison of Burr Hole Evacuation Versus Surgical Excision of Multiloculated Subdural Empyema

Objectives: We studied the results of results of comparison of burr hole evacuation versus surgical excision of multiloculated subdural empyema. Material and Methods: A total of 40 patients were admitted with the disease. We will analyze the results of 20 patients. It is a comparative observational study of 20 patients treated at the Punjab Institute of Neurosciences (PINS), Lahore. Presenting complaints of patients were fever, vomiting, headache, fits, etc. Results: The age range was 15 – 60 years. The mean age was 36 years, Medical management was given to 20 patients (100%) for 3 weeks. All patients were advised to take complete bed rest for 3 weeks. Anti-epileptic, Mannitol, antibiotics, and painkillers were the medications that were given. In this study, we will focus on the 20 patients treated surgically, and the analysis of 20 patients will be presented in complete detail. Our 10 (50%) patients were managed by burr hole evacuation of multiloculated subdural empyema. Surgical excision was done in 10 (50%) patients with multiloculated subdural empyema. Burr hole evacuation was done in patients who were old and unfit for surgery. Recurrence occurred in 5 (25%) patients who underwent management with burr hole evacuation and 1 (5%) patient in the excision group. Conclusion: The results of surgical excision of multiloculated subdural empyema are better than burr hole evacuation if the patient is for surgical excision.

Improved Outcomes in the First 72 Days of Medical Management of Cerebral Abscess in Post-Traumatic Patients

Objective: We studied the results of medical and surgical management of cerebral abscesses in post-traumatic patients after road traffic accidents (RTA). Material and Methods: It is a comparative observational study of 40 patients in Lahore General Hospital/Punjab Institute of Neurosciences (PINS), Lahore. Our patients were presented with fever, vomiting, headache, fits, etc. Results: The age range of our patients was 15-60 years. The mean age of our patients was 40 years, we gave medical management along with bed rest to all 40 patients (100%) for 3 weeks. Anti-epileptic, mannitol, antibiotics, and painkillers were the medication that was given. Our 30 (75%) patients who were managed medically, had headaches, and vomiting which did not resolve for we had to operate on the patients. Surgical management was done in 10 (25%) patients. Surgical excision was done in 9 (97%) patients and burr hole evacuation was done in 1 (3%) patients. All patients who recovered from medical management are those who were treated within 1st week after the occurrence of cerebral abscess. Conclusion: The results of medical management of cerebral abscess are better than surgical management if patients are treated during the first week after the occurrence of cerebral abscess. With good antibiotics etc.

Safety and Effectiveness of an Enhanced Recovery Protocol in Patients Undergoing Burr Hole Evacuation for Chronic Subdural Hematoma.

Enhanced recovery programs may be especially useful in patients with chronic subdural hematoma or hygroma (cSDH), who frequently exhibit frailty and multimorbidity. We aim to evaluate the real-world safety and effectiveness of an enhanced recovery protocol in this population. From a prospective registry, burr hole evacuations for cSDH carried out under the protocol (including early thromboprophylaxis, no flat bed rest, early mobilization without drain clamping, and early resumption of antithrombotic medication) were extracted, along with those procedures carried out within the past year before protocol change. Propensity score-based matching was carried out. A range of clinical and imaging outcomes were analyzed, including modified Rankin Scale as effectiveness and Clavien-Dindo adverse event grading as safety primary end points. Per group, 91 procedures were analyzed. At discharge, there was no significant difference in the modified Rankin Scale among the standard and enhanced recovery groups (1 [1; 2] vs 1 [1; 3], P = .552), or in Clavien-Dindo adverse event grading classifications of adverse events (P = .282) or occurrence of any adverse events (15.4% vs 20.9%, P = .442). There were no significant differences in time to drain removal (2.00 [2.00; 2.00] vs 2.00 [1.25; 2.00] days, P = .058), time from procedure to discharge (4.0 [3.0; 6.0] vs 4.0 [3.0; 6.0] days, P = .201), or total hospital length of stay (6.0 [5.0; 9.0] vs 5.0 [4.0; 8.0] days, P = .113). All-cause mortality was similar in both groups (8.8% vs 4.4%, P = .289), as was discharge disposition (P = .192). Other clinical and imaging outcomes were similar too (all P > .05). In a matched cohort study comparing perioperative standard of care with a novel enhanced recovery protocol focusing on evidence-based drainage, mobilization, and thromboprophylaxis regimens as well as changes to the standardized reuptake of oral anticoagulants and antiaggregants, no differences in safety or effectiveness were observed after burr hole evacuation of cSDH.

Template-based target point localization for occlusion of the middle meningeal artery during evacuation of space-occupying chronic subdural hematoma.

Endovascular middle meningeal artery (MMA) occlusion may help reduce the risk of recurrence after burr hole evacuation of chronic subdural hematoma (cSDH) but carries an additional periprocedural risk and remains hampered by logistical and financial requirements. In this study, the authors aimed to describe a simple and fast technique for preoperative MMA localization to permit burr hole cSDH evacuation and MMA occlusion through the same burr hole. The authors performed a preclinical anatomical and prospective clinical study, followed by a retrospective feasibility analysis. An anatomical cadaver study with 33 adult human skulls (66 hemispheres) was used to localize a suitable frontal target point above the pterion, where the MMA can be accessed via burr hole trephination. Based on anatomical landmark measurements, the authors designed a template for projected localization of this target point onto the skin. Next, the validity of the template was tested using image guidance in 10 consecutive patients undergoing elective pterional craniotomy, and the feasibility of the target point localization for cSDH accessibility was determined based on hematoma localization in 237 patients who were treated for a space-occupying cSDH in the authors' department between 2014 and 2018. In the anatomical study, the mean perpendicular distance from the zygomatic process to the target point in the frontoparietal bone was 4.1 cm (95% CI 4-4.2 cm). The mean length along the upper margin of the zygomatic process from the middle of the external auditory canal to the point of the perpendicular distance was 2.3 cm (95% CI 2.2-2.4 cm). The template designed according to these measurements yielded high agreement between the template-based target point and the proximal MMA groove inside the frontoparietal bone (right 90.9%; left 93.6%). In the clinical validation, we noted a mean distance of 4 mm (95% CI 2.1-5.9 mm) from the template-based target point to the actual MMA localization. The feasibility analysis yielded that 95% of all cSDHs in this cohort would have been accessible by the new frontal burr hole localization. A template-based target point approach for MMA localization may serve as a simple, fast, reliable, and cost-effective technique for surgical evacuation of space-occupying cSDHs with MMA obliteration through the same burr hole in a single setting.

Subgaleal drain versus dissection of subgaleal space and closure without drain after burr-hole drainage of chronic subdural hematoma.

Chronic subdural hematoma (CSDH) is a collection of blood, blood degradation products, and fluid that accumulate on the surface of the brain between its arachnoid and dural coverings. This study is to evaluate the efficacy of subgaleal drain (SGD) versus subgaleal dissection without drainage as adjuncts to burr-hole evacuation of CSDH. A retrospective study was conducted utilizing the data of 60 patients operated for symptomatic CSDH. Patients were divided into two groups, each thirty consecutive patients: Group I, in which a SGD was inserted after CSDH evacuation through a burr-hole; and Group II, the hematoma was evacuated as in the Group I, but with no SGD insertion but instead a subgaleal pocket was created for drainage. The neurological improvement at 24 h, discharge, 2 weeks, and 6 months after surgery was comparable in both groups. The overall recurrence was 4 cases (4/60, 6.7%). The rate of recurrence and surgical infection rate were comparable in both groups. Both groups showed similar incidences of postoperative seizures, bleeding, rates of medical complications, and neurological deficits. The overall postoperative mortality was five cases (5/60, 8.3%) with no significant difference between groups. Blunt dissection to open the subgaleal space and closure without a drain is a safe and efficient alternative to the insertion of a drain after the burr-hole evacuation of CSDH.

Single-Center Comparison of Chronic Subdural Hematoma Evacuation Outcomes Under Local Versus General Anesthesia

Chronic subdural hematoma (CSDH) is a neurosurgical pathology of an aged populace. Pathogenetic risk factors include traumatic brain injury, prolonged use of antiplatelet drugs, hypertension, and some inflammatory processes. The incidence increases as patients age. Burr-hole evacuation is the most common approach in management of symptomatic cases. We compared evacuation of chronic subdural hematomas with general or local anesthesia (GA and LA, respectively) and evaluated the safety, economic benefits, effects of comorbidity, benefits, and shortcomings of both techniques. We conducted a retrospective study of 67 consecutive patients who had 74 procedures for CSDH in a single neurosurgical center, the Regional Clinic, Centre of Neurosurgery and Neurology, over a 3-year period. They were grouped into the GA group (n= 44) and LA group (n= 23). Mean duration of procedure, length of hospital stay, complications, and preoperative and postoperative neurologic statuses were compared. The distribution of nominal variables between groups was compared using the Fisher exact test. The average duration of operation and length of hospital stay were compared using the Mann-Whitney U-test due to violation of the normality assumption. LA proved to be as effective as GA in CSDH evacuation. Seventy-four surgical procedures were performed on 67 patients due to recurrence in less than 30 days in 7 patients. Fifteen patients had tension pneumocephalus managed with fluid therapy to full recovery. LA was economical and required shorter hospital stays and surgical time. In our studies, LA proved to be noninferior to GA, time conserving, and less prone to some of the adverse effects of GA on elderly patients with comorbidity, although some patients who are hyperactive or contraindicated to LA will require GA.

Cortical blindness and brain stem ischemia following burr hole evacuation of chronic subdural hematoma

Background: Chronic SDH is commonly performed in neurosurgery. The surgery usually has good surgical outcomes. There have been few cases reports reporting cortical blindness and brain stem stroke as a dreaded complication of the same. Materials and methods: It is a retrospective, observational, descriptive type of study with analysis of patients operated for chronic SDH from March 2021 to March 2023 and reported an untoward outcome of vision loss or brainstem stroke following surgery. The cases have been reported with possible aetiology underlying the unfavourable outcome. The literature was reviewed for similar cases and a comparative analysis was done with possible hypotheses for the outcome. Observation and results: An overall 5 such cases have been reported during this period. Two cases of bilateral and three cases of unilateral chronic SDH have been reported. Out of five, two cases did not have a preceding history of trauma probably spontaneous in nature. Possibility of PRES in one case, transtentorial herniation, thrombosis, and spontaneous intracranial hypotension with kinking of vessels have been proposed. Further studies are required to address this untoward complication following evacuation of chronic subdural hematoma. Conclusions: A high index of suspicion, prompt recognition and management of reversible causes, slow decompression of hematoma especially in bilateral cases, and good hydration to prevent the possibility of thrombosis are key to preventing such complications. Also keeping the possibility in mind add on better counselling and prognostication of case in pre-surgery period.

Effectiveness and Safety of Burr Hole Evacuation in Chronic Subdural Hematoma Patients – Experience from a Low-Income Country

Background: In contemporary neurosurgery, burr holes are fundamental in cranial procedures, primarily for the evacuation of chronic subdural hematomas (CSDH). CSDH is prevalent, and its clinical course, though not life-threatening, carries morbidity and mortality risks. This study evaluates the effectiveness and safety of Burr Hole Evacuation (BHE) for CSDH, aiming to assess clinical outcomes, immediate postoperative complications, and patient satisfaction. Methodology: This retrospective cohort study analyzed data from patients who underwent BHE for CSDH between March 2015 and August 2023. Inclusion criteria encompassed well-documented CSDH diagnoses, comprehensive medical records, and primary BHE cases, excluding previous neurosurgical interventions and pediatric cases. Data included patient demographics, clinical presentation, imaging findings, surgical details, post-operative outcomes, and patient satisfaction. Analysis was performed using SPSS version 25. Results: The study included 86 patients, predominantly male (85%) with a mean age of 54 years. Clinical presentations varied, with headaches (85%) being the most common symptom. CT scans were pivotal for diagnosis, revealing hypodensities primarily over the convexity. BHE was performed without complications, resulting in favorable post-operative outcomes (93% significant recovery, 7% extended hospital stays). No intraoperative or post-operative mortality occurred, and there were no recurrent hematomas. Patient satisfaction with BHE was high (97%). Conclusion: BHE is a viable primary surgical intervention for CSDH in low-income settings, with positive outcomes, safety, and patient satisfaction. Further studies and collaborative efforts are essential to enhance neurosurgical treatment in these settings and explore long-term outcomes.

Endoscopic evacuation of chronic subdural hematoma with rigid and flexible endoscope: case report

Introduction: Subdural haematoma (SDH) is a common neurosurgical condition after head trauma requiring evacuation to prevent secondary brain injury. The first choice of management in these patients is a large craniotomy or burr-hole evacuation. However, sometimes due to lack vision during drain tube insertion or irrigation the authors might land up in a complication like cortical bridging vein rupture, haemorrhage etc. Also, the management of septate chronic SDH (CSDH) with multiple neo-membranes does not have a well-defined surgical approach. Recently, endoscopic evacuation has been reported to a be a feasible method for evacuation in acute, subacute and chronic SDH patients. Presentation of case: A 65-years-old male patient presented with a history of recent head injury and symptoms of headache and urinary incontinence of 7 days (Glasgow Coma Scale Score 15/15). Computed tomography scan revealed CSDH at both fronto-parietal convexity more on right side. Discussion: The authors reported our initial experience on a typical case of an older patient with chronic subdural haematoma and its evacuation with the assistance of both rigid and flexible endoscope. The authors could visualize cortical bridging veins and neo-membranes intraoperatively and guided our drainage tube accordingly to avoid inadvertent haemorrhage. There was no recurrence of symptoms postoperatively. Thus we achieved apparent successful evacuation of the CSDH in this patient in a 6-month follow-up. Conclusion: Endoscopic evacuation of CSDH proves to be an effective minimally invasive modality and more studies are required on larger patient groups with long-term follow-up imaging to confirm its superiority.