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Burr Hole Drainage versus Small Craniotomy of Chronic Subdural Hematomas
Yong Woo Shim1, Won Hee Lee1, Keun Soo Lee1
1Department of Neurosurgery, Inje University Busan Paik Hospital, Busan, Korea.
Insights
Burr hole drainage is effective for chronic subdural hematomas, showing a lower recurrence rate than small craniotomy. Small craniotomy may be necessary for complex hematomas with solid portions or septa.
Area of Science:
- Neurosurgery
- Surgical Procedures
- Neurological Disorders
Background:
- Chronic subdural hematoma (CSH) drainage is a common neurosurgical procedure.
- Both burr hole drainage and small craniotomy (3-5 cm) are utilized for CSH treatment.
- Comparing recurrence rates between these methods is crucial for optimal patient outcomes.
Purpose of the Study:
- To compare the postoperative recurrence rates of chronic subdural hematomas treated with burr hole drainage versus small craniotomy with closed-system drainage.
- To evaluate the efficacy of different surgical approaches for CSH management.
Main Methods:
- A retrospective study of 75 patients with symptomatic CSH from January 2016 to December 2018.
- Patients were treated with either burr hole drainage (60 patients) or small craniotomy (15 patients).
- Preoperative and postoperative computed tomography (CT) scans were used for evaluation; procedure choice was based on preoperative CT findings.
Main Results:
- The overall postoperative recurrence rate was 16%.
- Burr hole drainage had a recurrence rate of 13.3% (8/60), while small craniotomy had a recurrence rate of 46.7% (7/15).
- Hospitalization duration was shorter for burr hole drainage (10.3 days) compared to small craniotomy (15.7 days).
Conclusions:
- Burr hole drainage appears sufficient for most chronic subdural hematomas, offering a lower recurrence rate.
- Small craniotomy is indicated for complex cases, including those with solid components or multiple septa.
- The choice of surgical technique should be guided by the specific characteristics of the hematoma observed on preoperative imaging.
Objective:
Chronic subdural hematoma drainage is one of the most common procedures performed in neurosurgical practice. Not only burr hole drainage but also small craniotomy (diameter 3-5 cm) is frequently used neurosurgical treatment of chronic subdural hematomas. We assessed to compare the postoperative recurrence rates between burr hole drainage versus small craniotomy with closed-system drainage for chronic subdural hematomas.
Methods:
From January 2016 to December 2018, 75 patients who were treated with burr hole drainage and small craniotomy with closed system drainage for the symptomatic chronic subdural hematoma were enrolled. Pre and postoperative computed tomography (CT) were used for radiologic evaluation. The choice of procedure was decided by preoperative CT images.
Results:
60 patients out of 75 patients underwent burr hole drainage, whereas 15 patients underwent small craniotomy. The overall postoperative recurrence rate was 16%. The recurrence occurred in 8 patients out of 60 patients in burr hole drainage group (13.3%) and 7 patients out of 15 patients in small craniotomy group (46.7%). The number of days of hospitalization was 10.3 days in burr hole drainage group and 15.7 days in small craniotomy group.
Conclusion:
Burr hole drainage would be sufficient to evacuate chronic subdural hematoma with lower recurrence rate, but small craniotomy was also needed in some cases such as hematoma has solid portion or multiple septum.
