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Updated: Jul 29, 2025
A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
Burr hole locations are associated with recurrence in single burr hole drainage surgery for chronic subdural hematoma
Hiroaki Hashimoto1,2, Tomoyuki Maruo1, Yuki Kimoto1
1Department of Neurosurgery, Otemae Hospital, Osaka, Osaka, 540-0008, Japan.
Insights
Burr hole placement impacts chronic subdural hematoma recurrence. More lateral and ventral burr hole positions, along with bilateral hematomas and postoperative hemiplegia, increase the risk of CSDH recurrence requiring reoperation.
Area of Science:
- Neurosurgery
- Radiology
- Medical Statistics
Background:
- Chronic subdural hematoma (CSDH) recurrence is a significant clinical concern.
- Previous studies identified various risk factors, but quantitative analysis of CSDH and burr hole locations on recurrence is limited.
Purpose of the Study:
- To investigate the relationship between the anatomical locations of CSDH and burr hole placement and the recurrence of CSDH.
- To identify specific surgical factors influencing CSDH recurrence rates.
Main Methods:
- Retrospective analysis of 257 single burr hole surgeries for CSDH with drainage.
- Evaluation of patient demographics, CSDH volume, computed tomography values (CTV), and CSDH/burr hole locations using Montreal Neurological Institute coordinates.
Main Results:
- The overall recurrence requiring reoperation (RrR) rate was 13.5%.
- Higher RrR rates were observed in patients aged ≥76 years, those with bilateral CSDH, and those with postoperative hemiplegia.
- CSDH recurrence was associated with larger preoperative CSDH volume, smaller CTV, more lateral and ventral burr hole positions. CSDH location itself did not influence recurrence.
Conclusions:
- Burr hole location is a significant factor associated with CSDH recurrence.
- Ventral and lateral burr hole positions are linked to increased recurrence risk.
- Postoperative hemiplegia is a critical warning sign for CSDH recurrence.
Background:
Various factors have been reported as risk factors for chronic subdural hematomas (CSDH) recurrence. However, few studies have quantitatively evaluated the impact of CSDH locations and burr hole positions on recurrence. This study aimed to reveal the relation between CSDH recurrence and the locations of CSDH and burr holes.
Methods:
Initial single burr hole surgeries for CSDH with a drainage tube between April 2005 and October 2021 at Otemae Hospital were enrolled. Patients' medical records, CSDH volume, and CSDH computed tomography values (CTV) were evaluated. The locations of CSDH and burr holes were assessed using Montreal Neurological Institute coordinates.
Results:
A total of 223 patients were enrolled, including 34 patients with bilateral CSDH, resulting in 257 surgeries investigated. The rate of CSDH recurrence requiring reoperation (RrR) was 13.5%. The RrR rate was significantly higher in patients aged ≥76 years, those with bilateral CSDH, and those with postoperative hemiplegia. In RrR, the preoperative CSDH volume was significantly larger, and CTV was significantly smaller. The locations of CSDH had no influence on recurrence. However, in RrR, the locations of burr holes were found to be more lateral and more ventral. Multivariate Cox proportional hazards regression analysis showed that bilateral CSDH, more ventral burr hole positions, and postoperative hemiplegia were risk factors for recurrence.
Conclusions:
The locations of burr holes are associated with CSDH recurrence. In RrR, CSDH profiles tend to show a larger volume and reduced CTV. Hemiplegia after burr hole surgery serves as a warning sign for RrR.
