One vs. Two Burr Hole Craniostomy in Surgical Treatment of Chronic Subdural Hematoma

Abstract

Objective : Chronic subdural hematoma (CSDH) is one of the most common types of traumatic intracranial hemorrhage, usually occurring in the older patients, with a good surgical prognosis. Burr hole craniostomy is the most frequently used neurosurgical treatment of CSDH. However, there have been only few studies to assess the role of the number of burr holes in respect to recurrence rates. The aim of this study is to compare the postoperative recurrence rates between one and two burr craniostomy with closed-system drainage for CSDH. Methods : From January 2002 to December 2006, 180 consecutive patients who were treated with burr hole craniostomy with closed-system drainage for the symptomatic CSDH were enrolled. Pre-and post-operative computed tomography (CT) scans and/or magnetic resonance imaging (MRI) were used for radiological evaluation. The number of burr hole was decided by neurosurgeon's preference and was usually made on the maximum width of hematoma. The patients were followed with clinical symptoms or signs and CT scans. All the drainage catheters were maintained below the head level and removed after CT scans showing satisfactory evacuation. All patients were followed-up for at least 1 month after discharge. Results : Out of 180 patients, 51 patients were treated with one burr hole, whereas 129 were treated with two burr holes. The overall postoperative recurrence rate was 5.6% (n = 10/180) in our study. One of 51 patients (2.0%) operated on with one burr hole recurred, whereas 9 of 129 patients (7.0%) evacuated by two burr holes recurred. Although the number of burr hole in this study is not statistically associated with postoperative recurrence rate (p > 0.05), CSDH treated with two burr holes showed somewhat higher recurrence rates. Conclusion :In agreement with previous studies, burr hole craniostomy with closed drainage achieved a good surgical prognosis as a treatment of CSDH in this study. Results of our study indicate that burr hole craniostomy with one burr hole would be sufficient to evacuate CSDH with lower recurrence rate.

Treatment of chronic subdural hematoma: 5-year clinical experience

“…The burr hole technique is relatively safe, effective, technically easy to perform, and cost-efficient with a higher cure rate and a lower risk of recurrence and complications; for this reason the great majority of neurosurgeons currently favour burrhole craniostomy over other techniques (7,40). In recent studies, Taussky et al and Han et al pointed out that double burr-hole craniostomy instead of single burr-hole craniostomy has favorable outcomes and a lower rate of recurrent subdural hematoma (42,43).…”

A Comparative Study of Treatments for Chronic Subdural Hematoma: Burr Hole Drainage versus Burr Hole Drainage with Irrigation

“…However, whether drainage alone or drainage with irrigation is better for patients with CSDH remains unclear [1,2,4,5,[10][11][12][13][14][15][16][17].…”

One Versus Double Burr Holes for Treating Chronic Subdural Hematoma Meta-Analysis

“…There have been a few observational studies that compared recurrence rates of single versus double burr holes craniostomy in the treatment of CSH [2][3][4]11 , but those studies have conflicting results. post-operative recurrence of CSH requiring reoperation is a relatively infrequent but clinically significant complication after burr hole craniostomy 2 and by providing systematic review of the available studies in the literature examining SBHC versus DBHC, we aim to provide neurosurgeons with some evidencebased guidance in the treatment of patients with CSH.…”

“…The number of burr holes (one versus two) that are required to drain CSH and to minimize the risk of recurrence of CSH remains controversial among neurosurgeons 2,4,11 . Many neurosurgeons prefer to treat CSH with SBHC as it is faster to perform, it in theory reduces the opportunity for surgical complications, and it is cosmetically better for the patients as it involves only one incision.…”