Single Burr Hole Research Articles

Effectiveness of a single burr hole as a surgical technique for the management of chronic subdural hematoma: A clinical case series study

Effectiveness of a single burr hole as a surgical technique for the management of chronic subdural hematoma: A clinical case series study

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.

LGG-43. LASER-ASSISTED ENDOSCOPIC RESECTION OF TECTAL GLIOMA IN A 3-YEAR-OLD CHILD

Abstract BACKGROUND Pediatric tectal gliomas generally have a benign clinical course. However, some patients may present with non-communicating hydrocephalus needing endoscopic procedures. Historically, lasers have been used in neurosurgical procedures including neuroendoscopy, but their adoption was limited by a significant rate of complication due to their inappropriate wavelength and uncontrollable tissue interaction. Recently, a 2-micron near-infrared laser with adequate wavelength and minimal tissue penetration became available. CASE-REPORT We describe the case of a 3-year-old child who presented with gait ataxia, papilloedema and headache. Magnetic Resonance (MR) was performed and he was diagnosed with obstructive hydrocephalus due to tectal glioma. Endoscopic third ventriculostomy (ETV) and simultaneous endoscopic biopsy were performed during the same surgery using a single burr hole with a rigid endoscope, a 2-micron continuous-wave thulium laser and the aid of neuronavigation. After tumoral sample removal, the laser was used for hemostasis and to evaporate tissue near the tumour without mechanical stress to the brain tissue. The final histological analysis identified a non-otherwise specified (NOS) low-grade glioma. The hospitalization was uneventful and the boy was discharged home after 4 days. No new cognitive impairment was reported secondary to this procedure and the symptoms present in the preoperative period completely improved. At 1-year follow-up, neurological examination findings were unremarkable, and there was no radiographic evidence of tumour progression. CONCLUSIONS The use of the neuroendoscopic laser permits cutting and coagulating simultaneously, avoiding multiple instruments’ use (forceps and coagulation). It therefore makes neuroendoscopic procedures more straightforward with a minimum need to change tools, and particularly suitable also in a pediatric setting.

Colloid cyst of the third ventricle

Background: In the past, microsurgical resection was considered the gold standard treatment for colloid cysts. The endoscopic approach is gaining popularity and has been recognized as a safe and effective alternative to open surgery. Aims: To evaluate our results, safety and efficacy of the endoscopic approach Materials and methods: This retrospective study included seven patients with colloid cysts who underwent endoscopic resection between May 2020 and April 2022. Patient records, radiological images, and surgical notes were assessed. Follow-up data, including clinical and radiological details, were retrieved. Postoperative Computed tomography (CT) was performed, and magnetic resonance imaging (MRI) was performed in all patients. Result: Seven patients aged range 27-56 years 4 males and 3 females underwent endoscopic resection of the tumor during the study period. All patients presented with headaches. The mean diameter of the cyst was 10.6(range 8 -14mm), and the mean operating time was 126(range 100 -180 min). All patients underwent the single burr hole and single port technique. Six patients underwent transforaminal surgery and one patient underwent trans-septal corridor. GTR was achieved in six patients. One patient underwent near-total resection with coagulation of the capsule. None of the endoscopic procedures was converted to open resection. No patient had a recurrence, and the mean follow-up period was 24.3 (range 16 to 36 months). There were no deaths during the follow-up period. No residual cysts were observed on postoperative MRI in any patient. Conclusion: Endoscopic excision of colloid cysts is an effective and safe alternative method. Although the follow-up time was short, the residual cyst wall remained asymptomatic without any evidence of growth after near excision and coagulation of the wall.

PEDIATRIK PINEAL VE TEKTAL BÖLGE TÜMÖRLERI: Nöroendoskopi kullanımı

Purpose: In this article, we aimed to contribute to the literature by describing our approach to pediatric pineal and tectal masses treated with endoscopic interventions in our clinic.
 Materials and methods: We retrospectively reviewed the records of 26 patients with lesions in the pineal and tectal regions who underwent endoscopic procedures between 2012 and 2023 at Gazi University Department of Pediatric Neurosurgery. Demographic data, blood tumor markers (alpha fetoprotein-BETA AFP, alpha fetoprotein-β-hCG), pathological diagnoses, reasons for clinical presentation, presence of hydrocephalus and additional interventions were analyzed. 
 Results: Of the 26 patients who underwent endoscopic procedure, 6 had lesions in the pineal region and 20 had lesions in the tectal region. The success rate for ETV was 75-80%. The success rate for ETV was 78.3% for patients with tumors in the pineal region and 84% for tectal tumors.
 Conclusion: Pineal or tectal region tumors are a rare group of tumors. In addition, these regions are among the most heterogeneous regions in the central nervous system in terms of tumor type and histology. Endoscopic intervention through a single burr hole using rigid endoscopy is a comfortable and safe minimally invasive method for both pathologic sampling and management of hydrocephalus in indicated cases in the same session.

Burr Hole Hemispherotomy-Modification of Trans-Sylvian Peri-Insular Technique: 2-Dimensional Operative Video.

Trans-sylvian peri-insular hemispherotomy represents a functional hemispherectomy with minimal brain removal used for treatment of refractory hemispheric epilepsy.1 Exposure for this procedure is achieved by craniotomy. Refinement in the hemispherotomy technique, including trends toward minimizing cortical resection, has contributed to a substantial drop in complication rates.2 We present a refinement of this technique, allowing for complete hemispheric disconnection through a single burr hole. In this instance, this technique was applied in the case of a 4-year-old girl who presented with medically refractory epilepsy, which had developed on the first day of life due to a perinatal incomplete left middle cerebral artery stroke. Postoperatively, the patient experienced no worsening of her preexisting right-sided hemiparesis and remains seizure-free 18 months postoperatively, now off medication. While the trans-sylvian peri-insular hemispherotomy represents an established surgical technique, this is the first report of this procedure performed in a minimally invasive fashion through a single burr hole. Beyond the minimal incision and small aperture in the skull, seldom appreciated nuances of hemispheric disconnection are described and demonstrated, including amygdala disconnection, hippocampal tail disconnection directly into splenium disconnection, concomitant intermediate disconnection and callosotomy, and frontobasal disconnection landmarks. Consent was obtained from the patient's parents for the surgical procedure, use of outcome videos, and for publication of this video and associated materials. The participants and patient's parents consented to publication of their images and that of the patient.

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.

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

Efficacy of single burr hole with irrigation and sub-dural drain in the evacuation of chronic subdural hematoma

BackgroundChronic subdural hematoma (CSDH) remains one of the most common types of traumatic and spontaneous intracranial hematomas. The optimal method of treatment has not been definitely established. Surgical treatment options includes craniotomy, trephination, burrhole drainage and twist drill perforation. This study aimed at the evaluation of the clinical and radiological outcome after the efficacy of single burr hole with irrigation and sub-dural drain in the aim of successful evacuation of CSDH.ResultsA total of 53 patients were included in this study, the mean age of patients was 61.53 + 13.81 years. Results of the paired t test showed that the Glasgow coma scale has significantly improved by 0.89 points (p < 0.001) and that the average motor power has significantly improved for all individuals by 0.4 points (p = 0.043). We found that older aged patients have significantly less improvements in the postoperative motor power (r = − 0.317, p = 0.02) and require longer hospital stay (r = 0.32, p = 0.0197).ConclusionsA single burr hole with irrigation and leaving a subdural drain is safe procedure in managing subdural hematoma. We did not experience major adverse events related to drain insertion and efficient evacuation of collection and no obvious increase in mortality or morbidity rates.

Brain Abscess: A Comparison of Surgical Outcomes between Conventional Burr Hole Aspiration and Endoscope-assisted Evacuation.

Brain abscess is a major health problem with a significant morbidity and mortality rate. The objective of this study was to compare the surgical efficacy between endoscope-assisted evacuations of brain abscess with a single burr hole aspiration procedure in a tertiary health care center. This single center non-randomized clinical study was conducted in our Department of Neurosurgery during the period of July 2020 to December 2021. Patients under 30 years of age of both genders presented with brain abscess were enrolled in this study. Patients were treated with two different techniques and divided into 2 groups: conventional burr hole aspiration group and endoscope-assisted evacuation group. Thirty patients were enrolled for this study. The mean age was 13.0 ± 6.3 years in burr hole group and is 13.1 ± 6.4 years in endoscope-assisted group. This study showed ≥75.0% evacuation of brain abscess at 1st post-operative day in 13 (92.9%) patients in endoscope-assisted group and 5 (33.3%) patients in burr hole group. This study showed mortality rate of 6.7% in both the groups. Mean residual volume at 30th post-operative day was 0.75 ml in endoscope-assisted group and 1.75 ml in burr hole aspiration group. No patients treated with required endoscope-assisted evacuation required a repeated surgery, whereas 5 patients (33.3%) of patients treated with conventional burr hole required it. This study showed that endoscope-assisted procedure has better rate of abscess evacuation, less chance of residual and repeated surgeries than conventional burr hole.

Modified orbitozygomatic craniotomy with a single burr hole in the alternative sphenoid ridge keyhole

BackgroundOne-piece modified orbitozygomatic approach (OZA) is an extended version of the pterional approach that also includes orbital walls and frontal process of the zygomatic bone. For this craniotomy one burr hole must be placed in MacCarty keyhole and another - in the temporal region. ObjectiveTo develop a technique of the one-piece modified OZA with single a burr hole in the alternative sphenoid ridge keyhole that allows access to orbit, anterior cranial fossa and middle cranial fossa and apply it intraoperatively. MethodsA single human head specimen was used. The dissection was performed using standard surgical instruments high-speed Stryker drill. Every stage of the approach was photographed. We also report a surgical case of a patient with orbital cavernous hemangioma that was resected using the described technique. ResultsThe technique of the one-piece modified OZA with a single burr hole in the alternative sphenoid ridge keyhole is described, and its advantages and limitations are analyzed. The technique is used to totally resect an orbital cavernous hemangioma with good functional and cosmetic result. ConclusionModified OZA with a single burr hole in the sphenoid ridge keyhole is possible and may be an alternative to the classic technique. The advantages of this variation are the placement of just one burr hole and the preservation of a larger portion of the orbital roof. The latter facilitates better bone reconstruction and better cosmetic outcome. Disadvantages are the difficulty of identifying the location of the sphenoid ridge keyhole and risk of damaging the dura.

Neuroendoscopic transventricular transchoroidal approach for access to the posterior zone of the third ventricle or pineal region.

The endoscopic transventricular transchoroidal approach facilitates entry into the posterior part of the third ventricle, allowing a visualization field from the foramen of Monro to the pineal region through this anatomical corridor. Combined surgery to treat the target lesion and possible endoscopic third ventriculostomy (ETV) can be performed through a single burr hole. A detailed description of this surgical technique is given, and a series of cases from our center is presented. This retrospective study included patients with lesions in the pineal region or posterior zone of the third ventricle who underwent surgery between 2004 and 2022 in our center for tumor biopsy or endoscopic cyst fenestration. In nine cases, the transchoroidal approach was performed. Demographic and clinical variables were collected: sex, age at diagnosis, clinical presentation, characteristics of the lesion, pathological diagnosis, characteristics of the procedure, complications, subsequent treatments, evolution, follow-up time, and degree of success of the endoscopic procedure. The mean and range of the quantitative variables and frequency of the qualitative variables were analyzed, together with the statistical significance (p < 0.05). Surgical planning was carried out by performing a preoperative MRI, calculating the ideal entry point and trajectory for each case. The preoperative planning of the surgical technique is described in detail. Of our sample, 55.6% were women, with a mean age of 35years (7-78). The most common clinical presentation was intracranial hypertension (55.6%), with or without a focus. Eight patients presented hydrocephalus at diagnosis. The most frequent procedure was endoscopic biopsy with ETV (66.7%). The pathological diagnosis varied widely. Procedure-related complications included one case of self-limited bleeding of the choroidal fissure at its opening and one intraventricular hemorrhage due to tumor bleeding in the postoperative period. Non-procedure-related complications comprised two ETV failures and one case of systemic infection, while late complications included one case of disease progression and one case of radionecrosis. Four patients died, one due to poor neurological evolution after post-surgical tumor bleeding and three due to causes unrelated to the procedure. The rest of the patients had a favorable evolution and were asymptomatic or stable. The transchoroidal approach through a single burr hole is a feasible and safe option for access to the posterior part of the third ventricle. Proper planning of each case is necessary to avoid complications.

Factors for predicting recurrence after burr hole drainage for chronic subdural hematoma: a retrospective study.

Chronic subdural hematoma (SDH) is a common disease in the neurosurgical field, and hematoma drainage through burr hole trephination has been widely considered the optimal treatment for SDH. Despite numerous investigations aimed at predicting recurrence rates and associated factors, studies have demonstrated inconsistent results. In this study, we aimed to comprehensively determine the predictive factors of chronic SDH recurrence in surgically treated patients. We retrospectively evaluated 578 consecutive patients who underwent single burr hole surgery for chronic SDH at our institute between January 2008 and December 2021. Various clinical and radiological factors in patients with and without recurrence were compared using univariate and multivariate logistic regression analyses. A total of 438 patients (531 hemispheres) were analyzed. Fifty-four (10.17%) of the 531 hemispheres had recurrence of chronic SDH within 6months. Male sex (adjusted odds ratio (aOR) = 3.48; 95% confidence interval (CI), 1.42-8.49), bilateral hematomas (aOR = 2.14; 95% CI, 1.05-4.35), laminar hematoma type (aOR = 2.87; 95% CI, 1.23-6.71), > 30-cm3 volume of postoperative residual hematoma (aOR = 2.99; 95% CI, 1.01-8.83), and preoperative blood glucose level of ≥ 150mg/dL (aOR = 2.11; 95% CI, 1.10-4.05) were identified as independent factors associated with recurrence in multivariate logistic regression analysis. The present study revealed that male patients and those who had bilateral hematomas, laminar hematoma type, a large volume of hematoma after surgery, and a high preoperative blood glucose level had a higher probability of experiencing recurrent chronic SDH. We recommend close monitoring of patients 6months postoperatively to detect subsequent chronic SDH recurrence.

Single Burr Hole Repair of Ponds Fracture in Elderly Patient: Rare Presentation

Introduction: Ponds fracture is a common presentation in the young age group. It is not present in elderly patients because of the rigidity of the bone. Methods: In this case report, we are describing a repair of the ponds fracture in elderly patients with an elevation of the fractured segment with a single burr hole. Results: There was complete resolution of the continuity of the bone with 100% elevation of the bone. Conclusion: To our knowledge, pond fracture is not found in elderly patients and this is rare, so we tried to present it with the pictorial representations.

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.&#x0D; 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.&#x0D; 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

Endoscopic Excision of Third Ventricle Choroid Plexus Papilloma

Abstract Introduction Choroid plexus papilloma is a rare intraventricular tumor in children. Its management poses a challenge. Here we describe such a case of third ventricular choroid plexus papilloma and its endoscopic excision through a single burr hole. Case Description A 1-year-old child presented with headache, vomiting, and a large head with sunset sign and tense fontanel. Computed tomography (CT) and magnetic resonance imaging brain plain and contrast revealed dilated ventricles with a frondlike mass in the third ventricle with intense contrast enhancement, suggestive of choroid plexus papilloma of the third ventricle. The lesion was excised completely using an endoscope placed through a single burr hole at the right Kocher's point. Postoperative recovery was uneventful. The child was relieved of his symptoms. CT scan revealed complete removal of the lesion. Histopathology confirmed the diagnosis of choroid plexus papilloma. Results and Conclusion We document our surgical experience and present an edited video of the surgery. The key steps and nuances are described in the audio timeline. The authors acknowledge the feasibility of performing this complex surgery via a minimally invasive method, which has not been accepted routinely for this pathology.

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.

Teaching Neuro Images : Burkitt dural lymphoma mimicking a subacute subdural hematoma

A 59-year-old woman with no history of trauma presented with severe headaches and right-sided weakness. A CT scan showed a left hemispheric isodense subdural collection thought to be consistent with a subacute subdural hematoma (figure 1A). The patient underwent a single parietal burr hole for evacuation, but the neurosurgeon found subdural fleshy tissue and performed a biopsy. Immediate postoperative MRI showed a homogeneous hypercellular subdural mass (figure 1, B–F).1 Pathology was consistent with Burkitt lymphoma (figure 2). Retrospectively, the homogeneous density of the collection argued against hematoma. In nonemergent situations, an atypical radiologic appearance of a subdural hematoma may suggest the need for further radiologic investigations before surgical evacuation.2

Endoscopic third ventriculostomy and biopsy of a tectal lesion using flexible neuroendoscopy and urological cup forceps: illustrative case.

Tectal region tumors often clinically present as obstructive hydrocephalus due to mass effect on the outflow of the third ventricle and cerebral aqueduct. Pathology in this region varies; thus, biopsy can be of great value in the management decision making. Appropriate instrumentation remains an area of interest to further advance flexible neuroendoscopic techniques and applications. The authors report an illustrative case using flexible neuroendoscopy through a single burr hole for simultaneous endoscopic third ventriculostomy (ETV) and tectal tumor biopsy using urological cup forceps in a 13-year-old boy who had presented with obstructive hydrocephalus. The authors demonstrate the feasibility of simultaneous ETV and tectal lesion biopsy via flexible neuroendoscopy to address obstructive hydrocephalus and obtain a tissue biopsy in a single-site procedure. They found that the use of flexible cup forceps designed for uroscopy is an important complement to flexible neuroendoscopy. Given the evolving applications of flexible neuroendoscopy, this has implications for instrumentation adaptation and future design.