Single Burr Hole Drainage Research Articles

De novo primary malignant lymphoma of the dura following recurrent episodes of subdural abscess presenting as chronic subdural hematoma: illustrative case.

Chronic inflammation of the thorax, as in tuberculosis-related pyothorax, can cause secondary malignant lymphomas. However, primary malignant lymphoma of the central nervous system, specifically of the dura mater, developing after intracranial infection or inflammation has rarely been reported. Herein, the authors describe a case of primary dural lymphoma that developed secondary to subdural empyema, with an initial presentation mimicking a chronic subdural hematoma. A 51-year-old man had undergone single burr hole drainage for subdural empyema 2 years prior. The patient subsequently underwent multiple craniotomy and drainage procedures, with successful remission of the subdural empyema. He was subsequently referred to the authors' hospital approximately a year after his initial treatment because of a recollection of subdural fluid, which was suspected to be recurrent empyema. After another single burr hole drainage, which revealed only a subdural hematoma, a histopathological diagnosis of B-cell lymphoma of the dural/subdural membrane was made. Subsequent radiation therapy was completed, with good local control and no recurrence of the subdural hematoma confirmed at 2 months posttreatment. Intracranial lymphoma triggered by chronic inflammation is rare but should be considered a differential diagnosis in subdural hematomas for which the background pathology is unclear. https://thejns.org/doi/10.3171/CASE24153.

Burr hole locations are associated with recurrence in single burr hole drainage surgery for chronic subdural hematoma

BackgroundVarious factors have been reported as risk factors for chronic subdural hematomas (CSDH) recurrence. However, few studies have quantitatively evaluated the impact of CSDH locations and burr hole positions on recurrence. This study aimed to reveal the relation between CSDH recurrence and the locations of CSDH and burr holes. MethodsInitial single burr hole surgeries for CSDH with a drainage tube between April 2005 and October 2021 at Otemae Hospital were enrolled. Patients’ medical records, CSDH volume, and CSDH computed tomography values (CTV) were evaluated. The locations of CSDH and burr holes were assessed using Montreal Neurological Institute coordinates. ResultsA total of 223 patients were enrolled, including 34 patients with bilateral CSDH, resulting in 257 surgeries investigated. The rate of CSDH recurrence requiring reoperation (RrR) was 13.5%. The RrR rate was significantly higher in patients aged ≥76 years, those with bilateral CSDH, and those with postoperative hemiplegia. In RrR, the preoperative CSDH volume was significantly larger, and CTV was significantly smaller. The locations of CSDH had no influence on recurrence. However, in RrR, the locations of burr holes were found to be more lateral and more ventral. Multivariate Cox proportional hazards regression analysis showed that bilateral CSDH, more ventral burr hole positions, and postoperative hemiplegia were risk factors for recurrence. ConclusionsThe locations of burr holes are associated with CSDH recurrence. In RrR, CSDH profiles tend to show a larger volume and reduced CTV. Hemiplegia after burr hole surgery serves as a warning sign for RrR.

Letter to the Editor: Clinical and Radiologic Outcomes of Single Burr Hole Drainage and Mini-craniotomy in the Treatment of Inhomogeneous Chronic Subdural Hematoma: A Retrospective Study (Korean J Neurotrauma 2022;18:208-220).

Letter to the Editor: Clinical and Radiologic Outcomes of Single Burr Hole Drainage and Mini-craniotomy in the Treatment of Inhomogeneous Chronic Subdural Hematoma: A Retrospective Study (Korean J Neurotrauma 2022;18:208-220).

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.

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.

Comparison of Outcomes and Recurrence in Chronic Subdural Hematoma Patients Treated by Burr-Hole Drainage with or without Irrigation

Purpose Chronic subdural hematoma (CSDH) is a common disease in elderly patients and is usually treated by burr-hole drainage. However, the optimal surgical technique for treating CSDH has not been determined. In this study, we analyzed outcomes and recurrence rates after burr-hole drainage with or without irrigation in patients with CSDH. Methods Eighty-two CSDH patients treated with burr-hole drainage at Wonju Severance Christian Hospital from March 2015 to June 2016 were enrolled in this study. The subjects were divided into three groups based on the surgical technique performed as follows: single burr-hole drainage without irrigation (group A, n=47), single burr-hole drainage with irrigation (group B, n=14), or double burr-hole drainage with irrigation (group C, n=21). These three groups were compared with respect to clinical and radiological factors and the recurrence rate, and independent factors predicting recurrence were sought. Results After burr-hole drainage, CSDH recurred in 15 (18.3%) of the 82 patients, and six patients (7.3%) required reoperation. More specifically, recurrence was observed in 12 patients (25.5%) in group A, one (7.1%) in group B, and two (9.5%) in group C. The number of burr-holes did not significantly affect recurrence (odds ratio [OR]=0.38; 95% confidence interval [CI]: 0.60–2.38), but irrigation had a significant effect (OR=0.20; 95% CI: 0.04–0.97). Conclusions This study shows that irrigation during burr-hole surgery in CSDH patients significantly reduced the risk of recurrence, regardless of the number of burrholes used. We therefore recommend the use of active irrigation during burr-hole drainage surgery in CSDH patients. Keywords: Hematoma, subdural, chronic; Recurrence; Trephining

Take it seriously or not: postoperative pneumocephalus in CSDH patients?

Background: Pneumocephalus is a common finding after burr-hole drainage of chronic subdural hematoma (CSDH). Its effects have not been specifically studied.Methods: A retrospective analysis was performed in 140 patients with CSDH with single burr-hole drainage. The pre- and postoperative volumes of intracranial hematoma and the postoperative volume of pneumocephalus were calculated and analyzed with their relationships with Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) scores.Results: The preoperative hematoma volume and the patient ages are positively correlated with the 1-day postoperative pneumocephalus volume (p < 0.001, p < 0.01). There is no correlation between postoperative pneumocephalus volume and GCS/GOS scores (p > 0.05) and there is no difference of GCS/GOS scores or CSDH recurrence rate between patients with and without pneumocephalus (p > 0.05). The age and the volume of 1-day postoperative pneumocephalus are positively correlated with the absorbing rate of pneumocephalus (p < 0.01, p < 0.001).Conclusions: The pneumocephalus at a certain range has no effect on the prognosis of patients with CSDH and requires no specific intervention due to its self-absorbing capacity in the normal progress after surgery.HighlightsNo correlation between postoperative pneumocephalus volume and GCS/GOS scores.No difference of GCS/GOS or recurrence between patients with pneumocephalus or not.Pneumocephalus at certain range has no effect on the prognosis of patients.

The Potential of Diffusion-Weighted Magnetic Resonance Imaging for Predicting the Outcomes of Chronic Subdural Hematomas.

ObjectiveDiffusion-weighted magnetic resonance imaging (DW-MRI) has proven useful in the study of the natural history of ischemic stroke. However, the potential of DW-MRI for the evaluation of chronic subdural hematoma (CSDH) has not been established. In this study, we investigated DW-MRI findings of CSDH and evaluated the impact of the image findings on postoperative outcomes of CSDH.MethodsWe studied 131 CSDH patients who had undergone single burr hole drainage surgery. The images of the subdural hematomas on preoperative DW-MRI and computed tomography (CT) were divided into three groups based on their signal intensity and density: 1) homogeneous (iso or low) density on CT and homogeneous low signal intensity on DW-MRI; 2) homogeneous (iso or low) density on CT and mixed signal intensity on DW-MRI; and 3) heterogeneous density on CT and mixed signal intensity on DW-MRI. On the basis of postoperative CT, we also divided the patients into 3 groups of surgical outcomes according to residual hematoma and mass effect.ResultsAnalysis showed statistically significant differences in surgical (A to B: p<0.001, A to C: p<0.001, B to C: p=0.129) and functional (A to B: p=0.039, A to C: p<0.001, B to C: p=0.108) outcomes and treatment failure rates (A to B: p=0.037, A to C: p=0.03, B to C: p=1) between the study groups. In particular, group B and group C showed worse outcomes and higher treatment failure rates than group A.ConclusionCSDH with homogeneous density on CT was characterized by signal intensity on DW-MRI. In CSDH patients, performing DW-MRI as well as CT helps to predict postoperative treatment failure or complications.

The efficacy of Atorvastatin in reducing recurrence of chronic subdural hematoma after single burr hole drainage and irrigation

Objective To investigate the efficacy of Atorvastatin in reducing the recurrence rate of chronic subdural hematoma (CSDH) after single burr hole drainage and irrigation. Methods Between January 2000 and May 2005 and between January 2013 and December 2015, 122 patients with CSDH admitted to the Neurosurgery Department, Lanzhou General Hospital were treated with single burr hole drainage and irrigation under local anesthesia.All patients were classified into two groups.Patients in the treatment group (n=67) took Atorvastatin after operation and those in the control group (n=55) did not take Atorvastatin.Patient demographics, clinical characteristics, imaging data, Markwalder's Grading Scale (MGS) and recurrence rates were assessed. Results Preoperative clinical characteristics and MGS levels at discharge were similar between the two groups (all P>0.05). The recovery rate of CSDH was 98.5% in the treatment group, without recurrence or death.The recovery rate of CSDH was 96.4% in the control group, with four cases of relapse, making up a recurrence rate of 7.3% (4/55). As a result, the recurrence rates were statistically significantly different between the two groups (χ2=5.038, P=0.039). Conclusions Atorvastatin can significantly reduce the recurrence rate of CSDH after single burr hole drainage and irrigation. Key words: Atorvastatin; Hematoma, subdural; Recurrence; Drainage

Abstracts from The 12th Symposium of the International Neurotrauma Society February 1-4, 2016 Cape Town, South Africa.

Abstracts from The 12th Symposium of the International Neurotrauma Society February 1-4, 2016 Cape Town, South Africa.

Endoscope-assisted single burr hole drainage and irrigation of chronic subdural hematoma (SDH): A retrospective analysis

Background: Chronic subdural hematoma (SDH) is usually associated with mild trivial head trauma in the elderly population. Its treatment varies from multiple burr hole, irrigation, twist drill, and craniotomy for membranectomy. Objectives: 1) To describe the operative procedure of single burr hole, drainage, and irrigation assisted by an endoscope in the management of patients with chronic SDH and 2) to present its favorable outcome. Materials and Methods: Seventy-two patients were managed by endoscope-assisted single burr hole, drainage, and irrigation during the period from July 2008 to August 2013. All patients were given local anesthesia. Retrospective data at the times of admission, discharge, and at follow-up at 3 weeks and 6 weeks were analyzed. Results: The mean age of the patients was 65 years and males outnumbered females. Average operation time was 30 min. All patients were discharged at Markwalder's grade 0 within 3-4 days of admission. There were 1.38% cases of seizures but no cases with recurrences or mortality. On follow-up, 86.11% and 100% cases of full brain expansion were achieved at 3 and 6 weeks, respectively. Conclusion: Endoscope-assisted single burr hole drainage and irrigation of chronic SDH is simple, safe, and patient friendly. The short duration of this surgery performed in the elderly patients under local anesthesia is its biggest advantage.

Comparison of the Outcomes and Recurrence with Three Surgical Techniques for Chronic Subdural Hematoma: Single, Double Burr Hole, and Double Burr Hole Drainage with Irrigation.

ObjectiveChronic subdural hematoma (CSDH), a disease commonly encountered by neurosurgeons, is treated by burr hole drainage (BHD). However, the optimal surgical technique among the three types of BHD has not been determined.MethodsWe conducted a retrospective study on BHD performed on 93 patients who were diagnosed with CSDH. The subjects were divided into three groups based on the surgical technique performed: single BHD without irrigation (Group A, n=31), double BHD without irrigation (Group B, n=32), and double BHD with irrigation (Group C, n=30). The clinical factors, radiological factors and recurrences were compared between the three groups. Moreover, independent factors affecting the recurrence were analyzed.ResultsThe change in hematoma thickness was 29.77±7.94%, 49.73±12.87%, and 75.29±4.32% for Group A, B, and C, respectively, while the change in midline shift was 40.81±15.47%, 51.78±10.94%, and 56.16±16.16%, respectively. Thus, Group C showed the most effective for resolution of hematoma and midline shift (p<0.05). Group A, B, and C had 12 cases (38.7%), 8 cases (25.0%), and 3 cases (10.0%) of recurrences, respectively. Group C had a statistically significantly fewer recurrence rate than Group A (p<0.05). Double burr hole, irrigation, and coagulopathy were each identified as independent factors that reduce recurrence (p<0.05).ConclusionAmong the three techniques, the double BHD with saline irrigation resulted in the fewest recurrences. It is probably the most effective technique for preventing the recurrence of CSDH.

Comparative study between single versus double burr-hole drainage of unilateral chronic subdural haematoma

Chronic subdural haematoma (CSDH) is defined as the haematoma in the subdural space which tend to occur in the elderly several weeks after head injury. The incidence of CSDH varied from 1.72 per 100,000 inhabitants per year in Finland to 13.1 per 100,000 inhabitants per year in Japan with a peak incidence in the sixth and seventh decade of life. CSDH is a common treatable cause of dementia. The principal techniques used in the treatment of CSDHs are presently burr hole, twist drill craniostomy, craniectomy and craniotomy. The aim of this study was to assess clinical outcome in unilateral chronic subdural haematoma psatients treated by single or double burr-hole drainage. This clinical trial was carried out at the department of neurosurgery, BSMMU from June 2010 to November 2011. A total of 40 consecutive patients with their age ranged from 50 to 70 years with GCS 9 to 13 &amp; haematoma volume greater than 30cc were included in this study and randomly divided into two groups. In group A, patients with chronic subdural haematoma (CSDH) were managed with double burr-hole drainage. In group B, patients were managed with single burr-hole drainage. Clinical outcome was measured on the 1st post operative day, 3rd post operative day and at the time of discharge (usually on the 7th post operative day) and at 1 month follow-up by measuring Glassgow coma scale (GCS), improvement of limb weakness and Markwalder grading scale. In this study double burr-hole drainage and single burr-hole drainage surgery shows equal success in the management of CSDHs. DOI: http://dx.doi.org/10.3329/bmj.v43i1.21370 Bangladesh Med J. 2014 January; 43 (1): 13-16

Management of chronic subdural haematoma: Single burr-hole drainage and irrigation using the technique of “syringing”

BackgroundChronic subdural haematoma is one of the most common clinical conditions encountered in neurosurgical practice. The surgical approaches exhibit a wide spectrum ranging from simple burr-hole to complex craniotomy with excision of membrane. We tried to approach this condition with a procedure that is safer and faster using a single burr-hole for drainage and a technique of “syringing” the subdural space with normal saline for irrigation. AimsWe describe our technique of single burr-hole drainage and normal saline irrigation using the technique of “syringing”. Settings and designThis is a retrospective study wherein we analysed the data of the treated patients contained in the case sheets, operation theatre records and hospital discharge summaries. Methods and materialHundred fifty patients who had chronic subdural haematoma were treated surgically from April 2010 to March 2013. All the patients were operated under general anaesthesia. The clinical data at admission, discharge and 3 weeks following discharge was analysed as per the records. ResultsFavourable outcome was seen in all the 150 patients treated. None of the patients had any recurrence. Superficial wound infection was seen in only one patient which subsided with antibiotics. ConclusionsSingle burr-hole drainage and saline irrigation using the technique of “syringing” is a simple, fast and safe procedure for treating chronic subdural haematoma with a favourable outcome.

Chronic subdural hematomas: single or double burr hole-results of a randomized study.

To analyze the analysis of recurrence rates of single versus double burr holes in patients with subacute and chronic subdural hematomas. The study was a prospective randomized controlled trial on patients with subacute and chronic subdural hematomas. Collections with membranes or septae were excluded from the study. A written consent was taken from the patient or patient party after explaining the procedure. A total of 254 patients were enrolled in the study over a period of 18-months in the Department of Neurosurgery, Sheri-Kashmir-Institute of Medical Sciences, Srinagar, Kashmir. Recurrence rates in single and double-burr-hole groups were 6.15% and 4.83% respectively, which was not statistically significant. Most of the subdural hematomas can be dealt by single burr-hole drainage.

Chronic subdural haematomas: a comparative study of an enlarged single burr hole versus double burr hole drainage

Various surgical treatments have been proposed for the treatment of chronic subdural haematoma (CSDH). Herewith, we set out to compare the efficacy of an enlarged single burr hole versus double burr hole drainage for the treatment of CSDH. We studied patients with symptomatic CSDH proven by CT scan that were treated in our institute between January 2002 and January 2009. All patients were treated by an enlarged single or double burr hole drainage. A subdural drain was placed in all cases. A total of 245 patients were included in the study. Double hole drainage was performed in 156 (63.7%) patients (group A) and an enlarged single burr hole drainage in 89 (36.3%) patients (group B). There were nine recurrences in group A and five in group B; however, the difference was not statistically significant. There was no significant relationship between recurrence rate and age, gender, bilateral haematoma and antiplatelet or anticoagulant therapy. There was a trend towards higher risk of recurrence for patients with residual clots on postoperative CT scan. The mean hospitalization time was 6.2 days, and there was no significant difference between the two groups. No significant difference was found between patients' outcome, as assessed by Glasgow outcome scale score, and treatment method. Enlarged single burr hole and double burr hole drainage had the same efficacy in the treatment of CSDH.

Results of single burr hole drainage for acute subdural hematoma with non-reactive pupil

To investigate the effects of emergency burr hole drainage for acute subdural hematoma (ASDH) with bilateral non-reactive pupils. A retrospective study was conducted by reviewing medical records from 1998 to 2007. Patients meeting the following criteria were included: 1) head injury with unconsciousness (Glasgow Coma Scale score 8); 2) bilateral non-reactive pupils on arrival; 3) ASDH with disappearance of basal cistern on computed tomography (CT); and 4) performance of emergency single burr hole drainage. Subjects were divided into survival and non-survival groups. Pupil size on the small side was significantly smaller in the survival group than in the non-survival group. All pupils on the small side in the survival group were 4 mm. Emergency burr hole drainage should still be considered in patients with ASDH showing bilateral non-reactive pupils and one pupil 4 mm.

Treatment of Chronic Subdural Haematoma: Case for Single Burr-hole Craniostomy and Irrigation

Introduction: Chronic subdural haematoma (CSH) is a common neurosurgical disease in the elderly which can pose diagnostic challenge. The best means of its surgical management remains controversial. Current treatment options include burr-hole craniostomy, twist-drill craniostomy or craniotomy with or without closed tube drainage. While burr-hole craniostomy is often the most used technique, there are no articles that provided class 1 evidence with respect to recurrence rates and complications. Objective: To review retrospectively the results obtained in our centre using the single burr craniostomy with irrigation. Patients and Methods: Two cases of CSH are reported and our local experience analysed. The data were obtained by the review of all the records of CSH cases treated at the Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria between February 2006 and January 2008. Results: There were 22 patients (19 males, 3 females). All were operated on. The median age was 65years. Two patients were alcoholics and CSH followed endoscopic third ventriculostomy in one case. The most common side affected was the left (Left side 10, Right side- 8, Bilateral 5). Post-operatively there were neither recurrences nor mortality. Conclusion: We conclude that for the treatment of the CSH, single burr-hole drainage with irrigation is associated with acceptable and satisfactory outcome. But a long term study will be appropriate to appropriately document the long term recurrence rate.