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One vs. Two Burr Hole Craniostomy in Surgical Treatment of Chronic Subdural Hematoma
Hong-Joon Han1, Cheol-Wan Park, Eun-Young Kim
1Department of Neurosurgery, Gachon University of Medicine and Science, Gil Medical Center, Incheon, Korea.
Insights
For chronic subdural hematoma (CSDH), using one burr hole craniostomy with closed drainage may be sufficient for effective treatment. This approach appears to be associated with a lower recurrence rate compared to using two burr holes.
Area of Science:
- Neurosurgery
- Traumatology
- Radiology
Background:
- Chronic subdural hematoma (CSDH) is a common intracranial hemorrhage, particularly in elderly patients.
- Burr hole craniostomy with closed-system drainage is a standard neurosurgical treatment for CSDH.
- The impact of the number of burr holes on CSDH recurrence rates requires further investigation.
Purpose of the Study:
- To compare postoperative recurrence rates of chronic subdural hematoma (CSDH) treated with one versus two burr hole craniostomies.
- To evaluate the efficacy of single versus multiple burr hole approaches in CSDH management.
Main Methods:
- A retrospective analysis of 180 consecutive patients with symptomatic CSDH treated between 2002 and 2006.
- Patients underwent burr hole craniostomy with closed-system drainage, with the number of burr holes (one or two) determined by surgeon preference.
- Radiological assessment utilized pre- and post-operative CT scans and/or MRI, with follow-up including clinical evaluation and imaging for at least one month post-discharge.
Main Results:
- Out of 180 patients, 51 had one burr hole and 129 had two.
- The overall recurrence rate was 5.6% (10/180).
- Patients with one burr hole had a recurrence rate of 2.0% (1/51), while those with two burr holes had a 7.0% (9/129) recurrence rate. Although not statistically significant (p > 0.05), the two-burr-hole group showed a trend towards higher recurrence.
Conclusions:
- Burr hole craniostomy with closed drainage is an effective treatment for CSDH, yielding good surgical outcomes.
- A single burr hole craniostomy may be sufficient for evacuating CSDH.
- Employing one burr hole may be associated with a lower postoperative recurrence rate for CSDH.
Objective:
Chronic subdural hematoma (CSDH) is one of the most common types of traumatic intracranial hemorrhage, usually occurring in the older patients, with a good surgical prognosis. Burr hole craniostomy is the most frequently used neurosurgical treatment of CSDH. However, there have been only few studies to assess the role of the number of burr holes in respect to recurrence rates. The aim of this study is to compare the postoperative recurrence rates between one and two burr craniostomy with closed-system drainage for CSDH.
Methods:
From January 2002 to December 2006, 180 consecutive patients who were treated with burr hole craniostomy with closed-system drainage for the symptomatic CSDH were enrolled. Pre- and post-operative computed tomography (CT) scans and/or magnetic resonance imaging (MRI) were used for radiological evaluation. The number of burr hole was decided by neurosurgeon's preference and was usually made on the maximum width of hematoma. The patients were followed with clinical symptoms or signs and CT scans. All the drainage catheters were maintained below the head level and removed after CT scans showing satisfactory evacuation. All patients were followed-up for at least 1 month after discharge.
Results:
Out of 180 patients, 51 patients were treated with one burr hole, whereas 129 were treated with two burr holes. The overall postoperative recurrence rate was 5.6% (n = 10/180) in our study. One of 51 patients (2.0%) operated on with one burr hole recurred, whereas 9 of 129 patients (7.0%) evacuated by two burr holes recurred. Although the number of burr hole in this study is not statistically associated with postoperative recurrence rate (p > 0.05), CSDH treated with two burr holes showed somewhat higher recurrence rates.
Conclusion:
In agreement with previous studies, burr hole craniostomy with closed drainage achieved a good surgical prognosis as a treatment of CSDH in this study. Results of our study indicate that burr hole craniostomy with one burr hole would be sufficient to evacuate CSDH with lower recurrence rate.
