Double Burr Hole Research Articles

Comparison of Outcomes and Recurrence Rates in Patients Undergoing Single or Double Burr Hole Surgery for the Treatment of Chronic Subdural Hematoma

Comparison of Outcomes and Recurrence Rates in Patients Undergoing Single or Double Burr Hole Surgery for the Treatment of Chronic Subdural Hematoma

Comparison of outcomes and recurrence rates in patients undergoing single or double burr hole surgery for the treatment of chronic subdural hematoma in Bosnia and Herzegovina

IntroductionChronic subdural hematoma (CSDH) is a prevalent condition commonly seen in elderly individuals, often requiring neurosurgical intervention. Research questionThis study investigates patient characteristics and recurrence rates in CSDH patients treated with single or double burr hole surgery in Bosnia and Herzegovina. Methods: A retrospective study was conducted on patients treated for CSDH between January 2018 and December 2022. The diagnosis of CSDH was confirmed through preoperative CT or MRI of the brain. Patients underwent either single or double burr hole surgery based on the neurosurgeon's decision. Preoperative and postoperative brain CT scans, along with clinical outcomes, were analyzed. ResultsA total of 87 patients were included in the study, with 102 burr hole surgeries performed. Among these, 49 patients received single burr hole surgery, while 53 patients underwent double burr hole surgery. Recurrence of CSDH occurred in 8.8% of cases, with no significant difference observed between the groups. Notably, single burr hole surgery demonstrated comparable efficacy to double burr hole surgery in terms of subdural reduction and occurrence of pneumocephalus, while exhibiting fewer complications and shorter hospitalization. Discussion and conclusionsburr hole surgery, whether performed as a single or double procedure, is an effective treatment option for CSDH, as it leads to positive outcomes in both radiological and clinical assessments of patients following surgery. The population of Bosnia and Herzegovina receives good neurosurgical care for CSDH.

Surgical Treatment of Chronic Subdural Hematoma by Single Burr Hole under Local Anesthesia: Outcome of a Prospective Study

Purpose: Surgery is the usual treatment of chronic subdural hematoma: the most commonly used procedure is double burr hole craniostomy under general anesthesia for evacuation of the hematoma. However, there is an alternative technique which is single burr hole under local anesthesia. The purpose behind this study is evaluation of the prognosis of this technique in the management of CSDH according to the cause, clinical presentation, surgical procedure, and outcome.
 Methodology: In this prospective study, 41 patients with CSDH underwent single burr hole craniostomy under local anesthesia from June, 2022 to May, 2023, at West Erbil Emergency Hospital based on the etiology, clinical picture, surgical procedure, and complications. We excluded some cases from our study: age less than 20 years, uncooperative patients, and multilocular hematomas.
 Findings: Patients were from 20 to 85 years of age and the mean age was 65 years. Among them, 24 (58.5%) were males and 17 (41.4%) were females. Previous trauma was the major cause of CSDH in 27 (65.8%) followed by coagulopathy in in 7 (17%), anticoagulant or antiplatelet drugs in 5 (12%) and ICP hypotension in 2 (4%). Contralateral weakness was the most common presentation in 23 (56%), headache in 16 (39%) disturbance in level of consciousness in 10 (24.3%), and convulsion in 6 (14%).

Comparative Results of Surgical Treatment of Chronic Subdural Hematoma with Single and Double Burr Hole

Comparative Results of Surgical Treatment of Chronic Subdural Hematoma with Single and Double Burr Hole

A prospective randomized controlled trial of the effect of the number of burr hole on chronic subdural hematoma recurrence: An institutional experience

ObjectiveThe purpose of this study was to compare the effect of single burr hole (SBH) versus double burr hole (DBH) drainage on the recurrence rate of chronic subdural hematoma (CSDH). MethodForty-four patients undergoing burr hole craniostomy (BHC) between July 2022 and December 2022 were enrolled in a randomized clinical trial (RCT) comparing SBH to DBH surgeries. The primary endpoint of this study was the recurrence rate of CSDH. Radiological characteristics such as midline shift, thickness, volume, density, type of hematoma, brain atrophy and so on were secondary endpoints. ResultsForty-four patients participated in this study. Twenty-two hematomas underwent SBH craniostomy, and the other 22 had DBH craniostomy. The mean age in the SBH and DBH groups were 68.59 ± 7.94 and 69.54 ± 10.58, respectively. In each group, the proportion of males (SBH=16; DBH=15) was higher than that of females (SBH=6; DBH=7). The mean surgery time in the SBH group was significantly less than in the DBH group (p = 0.001). However, the two groups had no statistically significant difference in the CSDH recurrence rate (p = 0.312). ConclusionOur findings showed that SBH craniostomy is equally effective as DBH craniostomy at draining hematomas and does not increase the recurrence rate. Contrarily, the SBH craniostomy had a shorter surgical duration than the DBH craniostomy. As a result, we recommend SBH surgeries for all patients, with emphasis on the elderly and those with severe comorbidities, as well as in situations with few surgical facilities and a high patient admission rate.

Letter to the Editor Regarding: Single versus Double Burr Hole for Drainage of Chronic Subdural Hematoma: Randomized Controlled Study

Letter to the Editor Regarding: Single versus Double Burr Hole for Drainage of Chronic Subdural Hematoma: Randomized Controlled Study

Evaluating the optimal number of burr-holes for treating chronic subdural haematomas: good results from a single burr-hole?

Chronic subdural haematomas (cSDH) are one of the most common types of traumatic intracranial lesion. Burr-hole craniostomy followed by closed-system drainage has become the treatment of choice. However, there is no definitive indication as to the number of burr-holes needed. Our aim was to to assess clinical and radiological outcomes taking into account the number of burr-holes made. A retrospective single-centre-study was performed including patients treated for cSDH by performing burr-hole craniostomy from 2012 to 2018. After collecting data regarding demographics, comorbidities, and clinical and radiological records, haematomas were grouped depending on the number of burr-holes made (Group 1: single burr-hole; Group 2: double burr-holes). Clinical and radiological outcomes were statistically compared between groups, as well as the main complications. After collecting 171 patients, 205 cSDHs were analysed. 173 were treated with a single burr-hole (we called these Group 1) and 32 with double burr-holes (Group 2). No differences in preoperative characteristics were found between the groups, except for diabetes mellitus and previous antiplatelet/anticoagulation treatment. No radiological differences were found regarding haematoma volume (p = 0.7) or thickness (p = 0.3). Surgical site infection (p = 0.13), recurrence (p = 0.6), acute rebleeding (p = 0.25) and mortality (p = 0.94) were assessed without evidencing statistically significant differences. At the time of hospital discharge, most patients showed a remarkable clinical improvement, regardless of the number of burr-holes made (p = 0.7). This study suggests that cSDH can be efficiently evacuated by a single burr-hole craniostomy, a less invasive and shorter surgical procedure with quite good clinical outcomes and a low rate of complications.

Comparative Study of Single versus Double Burr Hole Drainage for Chronic Subdural Hematoma

Introduction: Various surgical technique is used for evacuation of chronic subdural hematoma. Burr hole drainage is a most preferred. However, there exist a controversy regarding single versus double burr hole among neurosurgeon. This study aims to compare the single versus double burr hole drainage for chronic subdural hematoma in terms of mortality, wound infection andrecurrence. Methods: A retrospective observational study was performed over the period of 3 years. Data were collected in terms age, gender, type of surgery, mortality, wound infection and recurrence. These data were analysed to compare between the single versus double burr hole groups. Results: A total of 53 patients with chronic subdural hematoma underwent burr hole drainage were enrolled. Mean age of patients was 61.87 ± 17.35 years with male to female ratio 4.88:1. In this study, single burr hole was performed in 35 patients (66%) versus double burr hole in 18 patients (34%). Superficial surgical site infection was observed in 3 patients (5.7%) wherein 1 from single burr hole and 2 from double burr hole group with no statistically significant association (P value = 0.26). There was only 1 recurrence (1.9%). This was from single burr hole group versus no recurrence from double burr hole group which was not statistically significant (P value = 1.00). There was no mortality in both the groups in this study. Conclusions: There is no effect on mortality, infection and recurrence comparing single versus double burr hole drainage following evacuation of chronic subdural hematoma. Keywords: burr hole drainage; chronic subdural hematoma; recurrence.

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 >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 & 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.

INCIDENTAL FINDING OF PITUITARY MACROADENOMA IN A PATIENT WITH CHRONIC SUBDURAL HAEMATOMA: A CASE REPORT

Background: With the advent of modern radiologic imaging there is increase in the detection of pituitary lesions in imaging done for others non-related lesion. The aim of this review is to report our first case of pituitary incidentaloma in a patient who was evaluated for chronic subdural haematoma Case Presentation: A 65-year-old known hypertensive presented initially to the internal physicians with severe headache, change in sensorium and right sided weakness. He has had history of a fall 6 weeks prior to presentation. His Glasgow coma scale score was 14/15 (E4V4M6). The power on his right upper and lower limbs was 3/5 and on the left limbs was 5/5. He had global exaggerated reflexes and hypertonia. Computerized Tomographic (CT) Scan of the brain done showed massive left subdural haematoma and 14 by 12 by 15 sellar mass. (Figure 1) Pituitary hormonal assay showed decrease in cortisol and other pituitary hormones with slight increase in prolactin. He subsequently had unilateral double burr hole and drainage. He did very well and was discharged 2 days after surgery. At his first follow up visit he was offered the option for further evaluation and treatment of the pituitary lesion but he declined due to financial constraints. Conclusion: Incidental finding of pituitary tumour is a reality in our setting. A lot need to be done to make modern radiological imaging readily available and affordable to increase yield.

Analysis of risk factors for prolong hospitalization in chronic subdural hematoma undergoing single burr hole and drainage

Introduction
 Single burr hole surgery for Chronic subdural hematoma (CSDH) is commonly performed neurosurgical procedure with >90% favorable outcome and less hospital stay. However, sometimes hospital stay may be prolonged due to associated prognostic factors, even in patients with favorable outcome. This study aims to analyze the early outcome of single burr hole and drainage surgery and factors that may be associated with prolong hospitalization.
 Materials and method
 A retrospective analysis of the patients who underwent single burr hole and drainage for CSDH from sept 2017 to may 2020 in Nepal Mediciti hospital. The patients with B/L CSDH, who underwent double burr hole and drainage or craniotomy evacuation or conservatively managed patients were excluded from the study. Early outcome was assessed using Glasgow outcome score at 7 days. Effect of use of antiplatelet/ anticoagulant drugs, age, comorbidity, preoperative Glasgow coma score on number of hospital stay was analyzed. Chi-square test was used for statistical analysis in SPSS version 25.
 Results
 Out of 85 patients, 73 were male. Mean age was 63.8 years. Early outcome in 7 days was favorable with GOS (4-5) in 90.6%. The use of antiplatelet or anticoagulant drugs was more common amongst patients with age > 70 years (p=0.01). The number of hospital stay was associated with age (p=0.00), antiplatelet or anticoagulant drugs (p=0.00), comorbidities (p=0.001), preoperative GCS(P=0.001) and GOS at 7 days (p=0.001).
 Conclusion
 Single burr hole and drainage surgery for CSDH mostly produce favorable outcome. The use of antiplatelet or anticoagulant drugs is more common in patients above 70 years. Age, antiplatelet or anticoagulant drugs, comorbidities, preoperative GCS, GOS at 7 days are related with longer hospital stay.

Single versus Double Burr Hole for Drainage of Chronic Subdural Hematoma: Randomized Controlled Study

Chronic subdural hematoma (CSDH) is one of the most common neurosurgical emergencies. Most neurosurgeons currently drained CSDH through single or double burr holes; however, few studies have compared the 2 approaches to drainage. The aim of this study is to compare the recurrent rate following double and single burr hole for CSDH in our practice. This is a randomized controlled study from January 2015 to December 2019 in a neurosurgical unit in Kaduna, Nigeria. All patients with imaging diagnosis of subacute or chronic subdural hematoma who enrolled in the study had either a single or double burr hole. Patients were followed up for 6 months after surgery to assess for recurrence. Data were analyzed using SPSS version 25 for Windows. The Fisher exact test was performed to compare the 2 treatment groups. A 2-sided P value < 0.05 was considered statistically significant. A total of 192 patients were enrolled in the study with 99 in the single-burr hole group and 93 in the double burr-hole group. The overall recurrence rate in this study was 2.6%. The recurrence rate in the single arm was 3%, and in the double arm it was 2.2%. There was no statistically significant difference in recurrence between the 2 groups (P= 1.000). A single burr hole is as efficacious as a double burr hole in terms of relief of symptoms and recurrence, and it has a shorter duration of surgery.

Practice variation in the conservative and surgical treatment of chronic subdural hematoma

ObjectiveChronic subdural hematoma (CSDH) is a condition that is frequently seen in the neurological and neurosurgical practice. Surgical treatment is overall preferred; however, conservative treatment is also an option. Both surgical and conservative treatment of CSDH vary across neurosurgeons. The aim of the present study was to evaluate different treatment strategies for CSDH among neurosurgeons in different countries. Material and MethodsWe designed a survey that was sent to neurosurgeons affiliated with the Congress of Neurological Surgeons.The questions were related to the conservative and surgical treatment methods of CSDH. Furthermore, we also included questions related to post-operative care. Results443 neurosurgeons completed the survey. 46.2 % of the respondents sometimes use dexamethasone as monotherapy. Overall, 26.2 % estimated dexamethasone to have a high efficacy on CSDH.A Glasgow Coma Score lower than 12 was considered to be the most important indication for surgery by 57.8 %. Double burr hole is the preferred surgical technique by 48.1 % of the respondents. One day after surgery, 69.3 % routinely orders a CT-scan. ConclusionsThe majority of the neurosurgeons worldwide remains reluctant in the use of conservative treatment methods in the management of CSDH. Further research is needed to assess the effectivity and side-effects of these conservative methods.

Single versus Double Burr Holes for Treating Chronic Subdural Hematoma

A subdural hematoma is a collection of blood below the inner layer of the dura but external to the bran and arachnoid membrane.Chronic subdural hematoma is commonly associated with cerebral atrophy, occur in the elderly after apparently insignificant head trauma. The incidence of Chronic subdural hematoma increases with age and after 70 years of age. Surgical evacuation of hematoma is indicated in patients who are clinically deteriorate or do not improve. Surgery can bring a rapid clinical improvement with a favorable outcome in over 80% of patient.&#x0D; Methods: This study was a prospective intervention study.&#x0D; Results: It was observed that 29 (96.6%) patients were alive in group A and 27 (90.0%) patients alive in group B in GOS scoring on the 7th POD. The alive patients were again divided into 4 sub groups, as shown in the table. Among total 60 patients, in Group A 1(3.4%) died and 3 (10.0%) died in Group B. After 3 months follow up, it was observed that 29 (96.6%) patients were alive in group A and 27 (90.0%) patients alive in group B. The alive patients were again divided into 4 sub groups, as shown in the table. Persistent vegetative and severe disability was not improved in Group B.&#x0D; Conclusion: In my study it was observed that the surgical outcome in single burr hole craniotomy is better than double burr hole craniotomy for treating of chronic subdural hematoma.&#x0D; Bang. J Neurosurgery 2020; 9(2): 99-104

Single Versus Double Burr Hole Craniostomy in Surgical Treatment of Chronic Subdural Hematoma: A Meta-Analysis

Chronic subdural hematoma (cSDH) is one of the most common illnesses seen in neurosurgery departments worldwide. For surgical treatment, some neurosurgeons prefer single burr hole craniostomy (SBHC), whereas others prefer double burr hole craniostomy (DBHC). We performed a meta-analysis to investigate whether DBHC is associated with increased risks of recurrence, complications and mortality compared with SBHC in patients with cSDH. Retrospective observational trial or randomized controlled trial (RCT) studies concerning burr hole craniostomy to treat cSDH were systematically identified through a search of electronic databases: PubMed, Web of Science, Embase, and Cochrane. Inclusion and exclusion criteria were defined for the eligible studies. The random fixed-effects model was used when heterogeneity was indicated; otherwise, a fixed-effects model was adopted. This meta-analysis included 12 studies, 3 of which were RCTs. Our findings can be summarized as follows. First, SBHC did not increase the risk of recurrence compared with DBHC in patients with cSDH (odds ratio [OR], 1.28; 95% confidence interval [CI], 0.92-1.78; P=0.07). Second, DBHC was not associated with an increased complication rate compared with SBHC in patients with cSDH (OR, 0.74; 95% CI, 0.20-2.76; P= 0.11). Third, DBHC did not increase mortality compared with SBHC in patients with cSDH (OR, 1.38; 95% CI, 0.55-3.46; P= 0.58). This meta-analysis demonstrates that there are no significant differences in recurrence rate, complication rate, and morbidity between SBHC and DBHC in the treatment of patients with cSDH.

Optimizing Burr Hole Placement for Craniotomy: A Technical Note.

Objective Usually, burr holes are placed along the line of a craniotomy. We describe a novel technique of burr hole placement to obtain smooth and beveled bony margin without any troughs and crests. Dural separation is obtained by minimizing the number of burr holes required. Methods Fifty craniotomies of diameter ranging from 3.5 to 11.5 cm were accomplished by placing burr hole in the center of bone flap rather than along the craniotomy line permitting 360 degrees of dura separation dependent on the length of dura separator. Craniotomy < 9 cm in diameter was performed by placing a single burr hole and a larger size craniotomy was performed with two burr holes. Parasagittal craniotomy was performedby placing burr hole not > 2.5 cm away from expected craniotomy site, namely superior sagittal sinus area enabling separation of adhered dura and venous sinuses. The bone cutter was used in a particular fashion to create smooth margin and beveled edges. Results Craniotomy < 9 cm in diameter was possible with single burr hole in 34 cases. Craniotomy larger than 9 cm in size was performed in 16 cases with double burr hole by strategically placing burr in the center of the desired bone flap. The craniotomy was achieved in all cases without damaging dura and venous structures. Conclusions An optimally placed single burr hole is sufficient for small to moderately large size craniotomy. Larger size craniotomy is possible with minimum numbers of burr holes. This achieves good cosmesis and avoids sinking of the bone flap.

Outcome of single burr hole under local anesthesia in the management of chronic subdural hematoma

BackgroundManagement of chronic subdural hematoma (CSDH) is usually surgical; burr hole craniostomy using double burr hole under general anesthesia is the most commonly used technique for its evacuation. However, single burr hole under local anesthesia may be an alternative deserving the study. The aim of this work is to evaluate the prognosis of single burr hole under local anesthesia in the management of CSDH according to the etiology, clinical picture, surgical technique, and prognosis.Patients and methodsWe studied 67 consecutive patients with CSDH operated by single burr hole craniostomy under local anesthesia from March, 2014, to February, 2015, at Zagazig University Hospitals according to the etiology, clinical picture, surgical technique, and complications. Exclusion criteria were age below 19 years, multilocular hematomas, and uncooperative patients. This is a prospective clinical study.ResultsThe age range was from 19 to 90 years with mean age of 60 years. There were 38 (56.7%) males and 29 (43.3%) females. The main cause of CSDH was old trauma in 43 (64.2%), liver disease in 14 (20.9%), antiplatelet in 8 (11.9%), and ICP hypotension in 2 (3%). Headache was found in 28 (41.8%), disturbed conscious level in 19 (25.4%), hemiparesis in 42 (62.7%), and seizure in 6 (9%). Markwalder scoring for CSDH at time of admission was 3 (4.48%) in grade 0, 20 (29.85%) in grade1, 23 (34.33%) in grade 2, 17 (25.37%) in grade 3, and 4 (5.97%) in grade 4. After evacuation, Markwalder score was 53 (79.01%) in grade 0, 13 (19.4%) in grade 1, 1 (1.50%) in grade 2, 0% in grade 3, and 0% in grade 4.ConclusionManagement of chronic subdural hematoma by single burr hole using local anesthesia is safe, effective, and sufficient for patient with unilocular cooperative CSDH patients with short hospital stay, low cost, and lower complication rate.Trial registrationClinicalTrials.gov Identifier: NCT03447327 registered on 26 February 2018. Retrospectively registered.

Single versus double burr-hole drainage for chronic subdural hematoma: A study of relevant prognostic factors conducted in Pakistan.

Objective:To compare the efficacy of single versus double burr-hole for drainage of chronic subdural hematoma, keeping in consideration pertinent demographic, pre and postoperative associations.Methods:A prospective cohort study carried out in Combined Military Hospital, Multan, (December 2016-August 2018), on adults with diagnosed chronic subdural hematoma (CSDH); being segregated by randomized control trial, non-probability purposive sampling into Group-A and Group-B (who underwent single and double burr-holes for CSDH-drainage respectively). Utilizing SPSS-21, data expressed as frequencies/percentages and mean± standard deviation (SD) and cross-tabulated; p-value <0.05 was taken as significant.Results:Age and GCS scores were 62±13.694 (range 38-94) and 11.00±3.350 (range 3-15) respectively, males being 40(66.7). Post-operative fatality was Nil, while 8(13.3%) and 14(23.3%) had post-operative seizures and recurrence of hematoma respectively. There was no significant association between type of burr-hole and hospital stay (p 0-884), seizures (p 0.448) or recurrence (p 0.542). Hospital stay (p<0.000) and seizures (p-0.005) were inversely proportional to GCS scores on presentation. Recurrence rates were not affected by age (p-0 .175) or gender (p-0 .281).Conclusion:There was no significant difference between outcomes of single and double burr-hole surgeries; the former must be preferred because of lesser iatrogenic trauma. GCS-score on presentation was validated as a negative association to anticipate post-operative outcomes.

Description of a Modified Technique (mini craniotomy–basal membranotomy) for Chronic Subdural Hematoma Surgery and Evaluation of the Contribution of Basal Membranotomy Performed as Part of This Technique to Cerebral Expansion

To determine the effectiveness of basal membranotomy performed to ensure cerebral expansion in patients operated for chronic subdural hematoma. Patients who were operated for unilateral chronic subdural hematoma and underwent basal membranotomy in addition to hematoma drainage were included in the first phase of the study. After the superficial membranous structures were excised, the maximum perpendicular distance between the internal tabula and the cerebral surface was measured after subdural hematoma evacuation. Subsequently, basal membranotomy was performed, the maximum perpendicular distance between the internal tabula and the cerebral surface was measured again, and the improvement in cerebral expansion was statistically calculated. The improvement of cerebral expansion in the patients who had undergone double burr hole drainage was statistically calculated in the second stage of the study. The cerebral expansion after the basal membrane excision was 41.1% in those with a 1.5- to 2-cm hematoma, 43.1% in those with a 2.1- to 3-cm hematoma, 43.5% in those with a 3.1- to 4-cm hematoma, and 45.4% in those with a hematoma thicker than 4 cm on average. No recurrence was seen during the 6-month follow-up in any patient. Double burr hole drainage revealed similar values for cerebral expansion increase with a mean value of 10%. The burr hole drainage was repeated because of recurrence in 5 patients during the 2-month follow-up. The mini craniotomy-basal membranotomy technique provided statistically significantly better cerebral expansion in patients with chronic subdural hematoma when compared with the double burr hole drainage technique.

Treatment Standards for Chronic Subdural Hematoma: Results from a Survey in Austrian, German, and Swiss Neurosurgical Units

Although an abundance of literature about the treatment of chronic subdural hematoma is available, it provides little evidence to clarify which treatment is most successful. The aim of this study was to examine and compare current clinical standards between several hospitals. Chairmen of all neurosurgical units in Austria, Germany, and Switzerland, as listed on the national neurosurgical societies' websites, were invited to participate with a personal token to access a web-based survey. A total of 159 invitations were sent and up to 5 reminder e-mails. Eighty-four invitees (53%) completed the survey. The most common surgical intervention was a single burr hole in 52 (65%) of the responding neurosurgical units, double burr holes were performed as primary procedure in 16 centers (20%), a small osteoplastic craniotomy in 4 (5%), and a twist drill craniostomy in 8 (10%). Seventy-two (90%) would place a drain in estimated 75%-100% of cases or whenever possible/safe. Sixty-five used subdural-external drains, and 7 used subgaleal-external drains. Seventeen applied suction to the drains. Thirty-six (49%) agreed with the statement that watchful waiting was an option for the treatment of chronic subdural hematomas and 19 (23.4%) disagreed. Eighteen (23%) would consider corticosteroids and 34 (45%) tranexamic acid as part of their armamentarium for the treatment of subdural hematomas. The results of this survey reflect the current evidence available in literature. Although the benefits of using of a drain are widely recognized, no consensus regarding the type of drain and surgical approach to the hematoma was reached.