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Updated: May 12, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Critical classification of craniostomy for chronic subdural hematoma; safer technique for hematoma aspiration
Masahiko Tosaka1, Kazuya Sakamoto, Saiko Watanabe
1Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan. nstosaka@med.guna-u.ac.jp
Insights
A new classification for chronic subdural hematoma (CSDH) surgery improves safety. This technique allows safe aspiration and irrigation via one burr-hole, reducing risks associated with the closed condition.
Area of Science:
- Neurosurgery
- Surgical Techniques
- Medical Imaging
Background:
- Chronic subdural hematoma (CSDH) is a common neurosurgical condition.
- Current treatments include twist drill and burr-hole craniostomies.
- Intraoperative conditions during CSDH evacuation can influence surgical safety and efficacy.
Purpose of the Study:
- To introduce a novel classification system for intraoperative CSDH conditions.
- To present a refined one-burr-hole craniostomy technique for safer CSDH aspiration.
- To evaluate the safety and efficacy of this technique in patients with symptomatic CSDH.
Main Methods:
- Classification of intraoperative CSDH conditions into "closed" and "open" based on cavity-extracranial space connections.
- Development and application of a one-burr-hole aspiration technique with air-saline exchange.
- Retrospective analysis of 27 patients undergoing the new technique.
Main Results:
- The classification system differentiates surgical risks between "closed" and "open" conditions.
- The one-burr-hole technique demonstrated safety and efficacy in the "open" condition.
- No significant complications were observed, with average recurrence rates.
Conclusions:
- The proposed classification aids in understanding intraoperative CSDH dynamics.
- The refined one-burr-hole technique offers a safe and efficient method for CSDH aspiration and irrigation.
- This approach minimizes risks, shortens operation time, and ensures adequate hematoma clearance.
Abstract:
Chronic subdural hematoma (CSDH) is generally treated by twist drill, and one and two burr-hole craniostomy. We proposed new classification of the intraoperative condition of CSDH, and present a safer technique for aspiration of CSDH in one burr-hole surgery. The intraoperative condition of CSDH was classified according to the connections between the hematoma cavity and the extracranial space as follows. The "closed condition" represents only a single route consisting of a tube inserted intraoperatively connecting the extracranial space to the hematoma cavity. The "open condition" includes another route or space, which can freely pass air, saline, or old hematoma fluid, in addition to the tube inserted intraoperatively. Twist drill craniostomy and two burr-hole craniostomy clearly involve the intraoperative closed and open conditions, respectively. One burr-hole craniostomy may involve either condition due to the operative procedure. Aspiration and irrigation of the hematoma is basically free and safe in the open condition, but risky in the closed condition. All of the hematoma can be aspirated through one burr hole under certain open conditions with temporary replacement of the hematoma cavity with air followed by replacement of air with saline. Twenty-seven patients with symptomatic CSDH underwent one burr-hole craniostomy by the above mentioned aspiration technique. There were no special complications. The recurrence rate was average. The substitution of saline after complete aspiration of hematoma carries little risk only under the "open condition," shortens the operation time, and achieves good irrigation of the hematoma.