Treatment Standards for Chronic Subdural Hematoma: Results from a Survey in Austrian, German, and Swiss Neurosurgical Units

Baschera, Dominik; Tosic, Lazar; Westermann, Leonard; Oberle, Joachim; Alfieri, Alex

doi:10.1016/j.wneu.2018.05.145

Cited by 26 publications

(27 citation statements)

References 34 publications

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“…Altogether it must be acknowledged, however, that placement of burr-hole covers is far from being a "gold standard" in today's clinical practice, considering the low rates of use and scarce literature regarding this issue. 1,4…”

Section: Awareness and Perception Of Relevancementioning

confidence: 99%

“…pying hematomas and significant or progressive clinical signs and symptoms. 1 With nonoperative treatment forms currently under evaluation, surgery remains the only existing treatment option proven to be effective today. 1,5,9,14 While neurosurgeons converge on the general concepts of trepanation, followed by dural opening and evacuation of the hematoma, the patterns of care vary significantly among individual surgeons, departments and countries with regards to technical nuances: 1 versus 2 burr holes, twist-drill craniotomy or mini-craniotomy with endoscopy-assisted hematoma clearance, drain versus no drain, among others.…”

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confidence: 99%

“…1,5,9,14 While neurosurgeons converge on the general concepts of trepanation, followed by dural opening and evacuation of the hematoma, the patterns of care vary significantly among individual surgeons, departments and countries with regards to technical nuances: 1 versus 2 burr holes, twist-drill craniotomy or mini-craniotomy with endoscopy-assisted hematoma clearance, drain versus no drain, among others. 1,2,4,7,9,10,12,13 A recent survey pointed out, however, that for nonacute hematomas, conventional burr-hole trepanation remains the most commonly performed procedure in most neurosurgical departments. 1 Despite their generally favorable risk profile and outcomes, burr-hole trepanations may lead to delayed scalp depressions and an unsatisfactory aesthetic outcome.…”

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confidence: 99%

“…1,2,4,7,9,10,12,13 A recent survey pointed out, however, that for nonacute hematomas, conventional burr-hole trepanation remains the most commonly performed procedure in most neurosurgical departments. 1 Despite their generally favorable risk profile and outcomes, burr-hole trepanations may lead to delayed scalp depressions and an unsatisfactory aesthetic outcome. Patients may feel troubled by stigmatization due to the visible skin depression, which typically develops over time with progressive hematoma resorption (Fig.…”

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confidence: 99%

“…4,12 However, placement of burr-hole covers is currently not the standard of care in clinical practice and the literature on this issue remains scarce. 1,4 We have received several comments regarding a recently published article on this topic, 12 and it appeared that opinions and patterns of care vary substantially among neurosurgeons with regard to burr-hole cover placement. Therefore, the objective of this study was to assess the practice variations among neurosurgeons in terms of burr-hole cover placement after burr-hole trepanation for patients with cSDH.…”

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confidence: 99%

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Patterns of care: burr-hole cover application for chronic subdural hematoma trepanation

Velz

Vasella

Akeret

et al. 2019

Neurosurgical Focus

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OBJECTIVESkin depressions may appear as undesired effects after burr-hole trepanation for the evacuation of chronic subdural hematomas (cSDH). Placement of burr-hole covers to reconstruct skull defects can prevent skin depressions, with the potential to improve the aesthetic result and patient satisfaction. The perception of the relevance of this practice, however, appears to vary substantially among neurosurgeons. The authors aimed to identify current practice variations with regard to the application of burr-hole covers after trepanation for cSDH.METHODSAn electronic survey containing 12 questions was sent to resident and faculty neurosurgeons practicing in different parts of the world, as identified by an Internet search. All responses completed between September 2018 and December 2018 were considered. Descriptive statistics and logistic regression were used to analyze the data.RESULTSA total of 604 responses were obtained, of which 576 (95.4%) provided complete data. The respondents’ mean age was 42.4 years (SD 10.5), and 86.5% were male. The sample consisted of residents, fellows, junior/senior consultants, and department chairs from 79 countries (77.4% Europe, 11.8% Asia, 5.4% America, 3.5% Africa, and 1.9% Australasia). Skin depressions were considered a relevant issue by 31.6%, and 76.0% indicated that patients complain about skin depressions more or less frequently. Burr-hole covers are placed by 28.1% in the context of cSDH evacuation more or less frequently. The most frequent reasons for not placing a burr-hole cover were the lack of proven benefit (34.8%), followed by additional costs (21.9%), technical difficulty (19.9%), and fear of increased complications (4.9%). Most respondents (77.5%) stated that they would consider placing burr-hole covers in the future if there was evidence for superiority of the practice. The use of burr-hole covers varied substantially across countries, but a country’s gross domestic product per capita was not associated with their placement.CONCLUSIONSOnly a minority of neurosurgeons place burr-hole covers after trepanation for cSDH on a regular basis, even though the majority of participants reported complaints from patients regarding postoperative skin depressions. There are significant differences in the patterns of care among countries. Class I evidence with regard to patient satisfaction and safety of burr-hole cover placement is likely to have an impact on future cSDH management.

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Section: Awareness and Perception Of Relevancementioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Patterns of care: burr-hole cover application for chronic subdural hematoma trepanation

Velz

Vasella

Akeret

et al. 2019

Neurosurgical Focus

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Perioperative Medical Management of Chronic Subdural Hematoma

Benzagmout

Armel²,

Boujraf

2021

Subdural Hematoma

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Improving the aesthetic outcome with burr hole cover placement in chronic subdural hematoma evacuation—a retrospective pilot study

et al. 2018

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BackgroundThe aesthetic outcome after burr hole trepanation for the evacuation of chronic subdural hematomas (cSDH) is often unsatisfactory, as the bony skull defects may cause visible skin depressions. The purpose of this study was to evaluate the efficacy of burr hole cover placement to improve the aesthetic outcome.MethodsWe reviewed consecutive patients treated by burr hole trepanation for cSDH with or without placement of burr hole covers by a single surgeon between October 2016 and May 2018. The clinical data, including complications, were derived from the institution’s prospective patient registry. The primary endpoint was the aesthetic outcome, as perceived by patients on the aesthetic numeric analog (ANA) scale, assessed by means of a standardized telephone interview. Secondary endpoints were skin depression rates and wound pain, as well as complications.ResultsFrom n = 33, outcome evaluation was possible in n = 28 patients (n = 24 male; mean age of 70.4 ± 16.1 years) with uni- (n = 20) or bilateral cSDH (n = 8). A total of 14 burr hole covers were placed in 11 patients and compared to 50 burr holes that were not covered. Patient satisfaction with the aesthetic outcome was significantly better for covered burr holes (mean ANA 9.3 ± 0.74 vs. 7.9 ± 1.0; p < 0.001). Skin depressions occurred over 7% (n = 1/14) of covered and over 92% (n = 46/50) of uncovered burr holes (p < 0.001). There was no difference in wound pain (p = 0.903) between covered and uncovered sites. No surgical site infection, cSDH recurrence, or material failure was encountered in patients who had received a burr hole plate.ConclusionsIn this retrospective series, placement of burr hole covers was associated with improved aesthetic outcome, likely due to reduction of skin depressions. A randomized controlled trial is developed to investigate whether adding burr hole covers results in superior aesthetic outcomes, without increasing the risk for complications.

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Treatment Standards for Chronic Subdural Hematoma: Results from a Survey in Austrian, German, and Swiss Neurosurgical Units

Cited by 26 publications

References 34 publications

Patterns of care: burr-hole cover application for chronic subdural hematoma trepanation

Patterns of care: burr-hole cover application for chronic subdural hematoma trepanation

Perioperative Medical Management of Chronic Subdural Hematoma

Improving the aesthetic outcome with burr hole cover placement in chronic subdural hematoma evacuation—a retrospective pilot study

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