Korean J Neurotrauma.  2014 Oct;10(2):76-81. 10.13004/kjnt.2014.10.2.76.

The Efficacy of Titanium Burr Hole Cover for Reconstruction of Skull Defect after Burr Hole Trephination of Chronic Subdural Hematoma

• Im TS
• Lee YS
• Suh SJ
• Lee JH
• Ryu KY
• Kang DG

• KMID: 2256235
• DOI: http://doi.org/10.13004/kjnt.2014.10.2.76

Abstract

OBJECTIVE
Although burr hole trephination is a safe and effective surgical option to treat patients with chronic subdural hematoma (CSDH), it often results in a small but undesirable scalp depression from burr hole defect. This study is to evaluate the efficacy of titanium burr hole cover (BHC) for reconstruction of skull defects in these patients.
METHODS
A hundred and ninety-six cases of burr hole trephinations for CSDHs between January 2009 and December 2013 were assigned into two groups; Gelfoam packing only (GPO) and reconstruction using titanium BHC group, according to the modalities of burr hole reconstructions. The incidences and depths of scalp depressions and incidences of postoperative complications such as infections or instrument failures were analyzed in both groups. We also conducted telephone surveys to evaluate the cosmetic and functional outcomes from patient's aspect.
RESULTS
Significantly lower incidence (p<0.0001) and smaller mean depth (p<0.0001) of scalp depressions were observed in BHC than GPO group. No statistical differences were seen in postoperative infection rates (p=0.498) between the two groups. There were no instrument failures in BHC group. According to the telephone surveys, 73.9% of respondents with scalp depressions had cosmetic inferiority complexes and 62.3% experienced functional handicaps during activities of daily life.
CONCLUSION
Titanium BHC is highly effective for reconstruction of skull defect after burr hole trephination of CSDH, and provides excellent cosmetic and functional outcomes without significant complications.

Keyword

Burr hole cover; Hematoma subdural chronic; Titanium; Treatment efficacy

MeSH Terms

Surveys and Questionnaires
Depression
Gelatin Sponge, Absorbable
Hematoma, Subdural, Chronic*
Humans
Incidence
Postoperative Complications
Scalp
Skull*
Telephone
Titanium*
Treatment Outcome
Trephining*
Titanium

Figure

• 

  FIGURE 1 The intraoperative photograph shows a repaired burr hole defect using a titanium burr hole cover (BHC) after a burr hole trephination. The BHC can be easily fixed with only two self-drilling screws (black arrowheads) even though it has five screw holes around. Note that the small gap or opening at the edge allows maintenance of a drainage catheter (white arrowhead).

• 

  FIGURE 2 A: A brain computed tomography (CT) of a patient after burr hole trephination shows a severe scalp depression (white arrow) from burr hole defect after reconstruction with Gelfoam packing only. B: Another brain CT shows no definite scalp depression after reconstruction with a titanium burr hole cover (white arrowhead).

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