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Updated: Nov 11, 2025

A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
Chronic subdural hematoma under local anesthesia with manual burr hole
Nathan Beucler1,2, Aurore Sellier3, Cédric Bernard3
1Neurosurgery Department, Sainte-Anne Military Teaching Hospital, 2 boulevard Sainte-Anne, 83800, Toulon Cedex 9, France. nathan.beucler@neurochirurgie.fr.
Context:
Burr hole evacuation (BHE) of symptomatic chronic subdural hematoma (CSH) carries significant morbidity and mortality in the elderly because they are a fragile population. As military neurosurgeons, we perform a simplified technique under local anesthesia using a manual craniotome.
Methods:
We present the case of an 85-year-old woman suffering from a right-sided CSH causing confusion and severe left-sided hemiparesis.
Conclusion:
After the procedure, the patient presented immediate neurological improvement. Performing manual BHE of symptomatic CSH under local anesthesia is safe, and it is of great interest for very old patients or in case of strained resources, thus we think that this technique should be taught to every young neurosurgery resident.
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