Korean J Neurotrauma.  2019 Oct;15(2):110-116. 10.13004/kjnt.2019.15.e25.

Burr Hole Drainage versus Small Craniotomy of Chronic Subdural Hematomas

• Shim YW
• Lee WH
• Lee KS
• Kim ST
• Paeng SH
• Pyo SY

• KMID: 2461115
• DOI: http://doi.org/10.13004/kjnt.2019.15.e25

Abstract

OBJECTIVE
Chronic 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.
METHODS
From 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.
RESULTS
60 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.
CONCLUSION
Burr 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.

Keyword

Chronic subdural hematoma; Trephining; Craniotomy; Recurrence

MeSH Terms

Craniotomy*
Drainage*
Hematoma
Hematoma, Subdural, Chronic*
Hospitalization
Humans
Recurrence
Trephining

Figure

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  FIGURE 1 (A) Pre-operative computed tomography showed isodensity crescentic shaped hematoma in left frontotemporoparietal area. (B, C) Seventy-one-year-male patient with chronic subdural hematoma underwent burr hole drainage in left parietal area.

• 

  FIGURE 2 (A) Pre-operative computed tomography showed heterogenous, crescentic shaped hematoma in left frontotemporoparietal area. (B, C) Seventy-six-year-male patient with chronic subdural hematoma underwent small craniotomy with drainage in left parietal area.

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