Related Experiment Video
Updated: Apr 18, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Burr hole washout versus craniotomy for chronic subdural hematoma: patient outcome and cost analysis
Jacqueline M Regan1, Emmagene Worley2, Christopher Shelburne3
1University of Michigan, Ann Arbor, MI, United States of America.
Insights
Burr hole washout is a more effective surgical treatment for chronic subdural hematomas (CSDH) than craniotomy. This neurosurgical procedure leads to better patient outcomes, shorter hospital stays, and lower costs, with fewer patients requiring repeat surgeries.
Area of Science:
- Neurosurgery
- Surgical Procedures
- Medical Outcomes
Background:
- Chronic subdural hematomas (CSDH) are common in neurosurgery and typically treated with surgical drainage.
- Current surgical techniques for CSDH lack definitive evidence of superiority, leading to varied practices.
- Patient care decisions may be influenced by factors unrelated to clinical outcomes due to this uncertainty.
Purpose of the Study:
- To compare the efficacy and outcomes of burr hole washout versus craniotomy for CSDH surgical drainage.
- To evaluate re-operation rates, mortality, morbidity, length of stay, and cost-effectiveness of the two procedures.
- To provide data to inform surgical decision-making for CSDH treatment.
Main Methods:
- Retrospective chart review of 119 patients undergoing surgical drainage for CSDH.
- Comparison of outcomes between patients treated with craniotomy (58) and burr hole washout (61).
- Analysis included re-operation rates, Glasgow Coma Scale (GCS), Rankin disability scores, discharge disposition, length of stay, and procedure costs.
Main Results:
- Burr hole washout demonstrated superior patient outcomes, reduced length of stay, and lower recurrence rates compared to craniotomy.
- Re-operation was required in 6.6% of burr hole patients versus 24.1% of craniotomy patients (P = 0.0156).
- Burr hole washout procedures were shorter (78.8 vs. 129.4 minutes), less costly ($2,828 less per patient based on OR time), and associated with a 3-day shorter mean hospital stay.
Conclusions:
- Burr hole washout is clinically and financially superior to craniotomy for treating CSDH based on this retrospective analysis.
- The findings suggest burr hole washout offers better patient outcomes and cost-effectiveness.
- Prospective, long-term, multicenter clinical studies are necessary to validate these results.
Abstract:
Chronic subdural hematomas (CSDH), which are frequently encountered in neurosurgical practice, are, in the majority of cases, ideally treated with surgical drainage. Despite this common practice, there is still controversy surrounding the best surgical procedure. With lack of clear evidence of a superior technique, surgeons are free to base the decision on other factors that are not related to patient care. A retrospective chart review of 119 patients requiring surgical drainage of CSDH was conducted at a large tertiary care center over a three-year period. Of the cases reviewed, 58 patients underwent craniotomy, while 61 patients underwent burr hole washout. The study focused on re-operation rates, mortality, and morbidity, as measured by Glasgow coma scores (GCS), discharge Rankin disability scores, and discharge disposition. Secondary endpoints included length of stay and cost of procedure. Burr hole washout was superior to craniotomy with respect to patient outcome, length of stay and recurrence rates. In both study groups, patients required additional surgical procedures (6.6% of burr hole patients and 24.1% of craniotomy patients) (P = 0.0156). Of the patients treated with craniotomy, 51.7% were discharged home, whereas 65.6% of the burr hole patients were discharged home. Patients who underwent burr hole washout spent a mean of 78.8 minutes in the operating suite while the patients undergoing craniotomy spent 129.4 minutes (P < 0.001). The difference in mean cost per patient, based solely on operating time, was $2,828 (P < 0.001). This does not include the further cost due to additional procedures and hospital stay. The mean length of stay after surgical intervention was 3 days longer for the craniotomy group (P = 0.0465). Based on this retrospective study, burr hole washout is superior for both patients' clinical and financial outcome; however, prospective long-term multicenter clinical studies are required to verify these findings.
