Burr Hole Drainage versus Small Craniotomy of Chronic Subdural Hematomas

Abstract

ObjectiveChronic 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.MethodsFrom 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.Results60 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.ConclusionBurr 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.

Burr Hole Surgery for Drainage of Chronic and Subacute Subdural Hematomas: Low Recurrence Rate in a Single Surgeon Cohort

“…In the series by Raghavan et al, a burr hole had a greater recurrence rate (15.5%) than a craniotomy (7.5%) [18]. However, Shim et al found a higher incidence with craniotomy (47%) than burr hole (13%) [9]. Haron et al found no significant difference associated with the type of procedure used [7].…”

“…A literature review showed that recurrence rates for C/SA-SDH ranged between 0% and 20% [1][2][3][4][5][6][7][8][9][10]. Recurrence rates varied widely, which may partially be due to different technical strategies used by the surgeons involved.…”

The Mini-Craniotomy for cSDH Revisited: New Perspectives

“…Treatment options for cSDH include surgery (15)(16)(17), observation and medications such as dexamethasone (12,(18)(19)(20) and endovascular obliteration of the meningeal artery (21)(22)(23)(24)(25). There have been numerous studies examining the different procedures.…”

“…There have been several studies demonstrating that endoscopic assisted burr hole drainage of the cSDH aids in the visualization of formed or sequestered hematomas as well as septations and membranes (29). Critics of craniotomies for cSDH argue that the operative time is higher and there is more morbidity and mortality in comparison to burr hole drainage (15,30). Reports of craniotomies for cSDH frequently include both large and minicraniotomies.…”

“…Critics of craniotomies for cSDH argue that the operative time is higher and there is more morbidity and mortality in comparison to burr hole drainage ( 15 , 30 ). Reports of craniotomies for cSDH frequently include both large and mini-craniotomies.…”