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Burr hole trepanation and insertion of a subperiosteal drain for chronic subdural haematoma: how I do it

  • How I Do it - Neurosurgery general
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Abstract

Background

Burr hole trepanation (BHT) is the most commonly used surgical method for the treatment of chronic subdural haematoma (cSDH).

Method

We give a brief overview on the indication for surgical treatment of cSDH, the surgical technique of BHT, and specific perioperative considerations. In particular, we emphasise on the technique of a subperiosteal drain placement.

Conclusion

BHT is a valid option to treat chronic subdural haematoma. Careful surgical technique and placement of a subperiosteal drain is required to minimise complications and improve outcome.

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References

  1. Kamenova M, Lutz K, Schaedelin S, Fandino J, Mariani L, Soleman J (2016) Does early resumption of low-dose aspirin after evacuation of chronic subdural hematoma with burr-hole drainage Lead to higher recurrence rates? Neurosurgery 79(5):715–721

    Article  Google Scholar 

  2. Licci M, Kamenova M, Guzman R, Mariani L, Soleman J (2018) Influence of postoperative thrombosis prophylaxis on the recurrence of chronic subdural hematoma after burr-hole drainage. Crit Care Med 46(1):e26–e32

    Article  Google Scholar 

  3. Poon MTC, Al-Shahi Salman R (2018) Association between antithrombotic drug use before chronic subdural haematoma and outcome after drainage: a systematic review and meta-analysis. Neurosurg Rev 41(2):439–445

    Article  Google Scholar 

  4. Santarius T, Kirkpatrick PJ, Ganesan D et al (2009) Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet 374(9695):1067–1073

    Article  Google Scholar 

  5. Santarius T, Kirkpatrick PJ, Kolias AG, Hutchinson PJ (2010) Working toward rational and evidence-based treatment of chronic subdural hematoma. Clin Neurosurg 57:112–122

    PubMed  Google Scholar 

  6. Soleman J, Lutz K, Schaedelin S, Kamenova M, Guzman R, Mariani L, Fandino J (2019) Subperiosteal vs subdural drain after burr-hole drainage of chronic subdural hematoma: a randomized clinical trial (cSDH-drain-trial). Neurosurgery 85(5):E825–E834

    Article  Google Scholar 

  7. Soleman J, Nocera F, Mariani L (2017) The conservative and pharmacological management of chronic subdural haematoma. Swiss Med Wkly 147:w14398

    PubMed  Google Scholar 

  8. Unterhofer C, Freyschlag CF, Thomé C, Ortler M (2016) Opening the internal hematoma membrane does not alter the recurrence rate of chronic subdural hematomas: a prospective randomized trial. World Neurosurg 92:31–36

    Article  Google Scholar 

  9. Weigel R (2003) Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry 74(7):937–943

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland

    Florian Ebel, Raphael Guzman & Jehuda Soleman

  2. Division of Pediatric Neurosurgery, University Children’s Hospital of Basel, Basel, Switzerland

    Raphael Guzman & Jehuda Soleman

  3. Faculty of Medicine, University of Basel, Basel, Switzerland

    Raphael Guzman & Jehuda Soleman

Authors
  1. Florian Ebel
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  2. Raphael Guzman
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  3. Jehuda Soleman
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Corresponding authors

Correspondence to Florian Ebel or Jehuda Soleman.

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Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Key points

- BHT is considered, to date, the gold standard surgical technique for drainage of cSDH.

- BHT of cSDH is indicated in symptomatic patients or haematomas leading to a significant space-occupying effect.

- The insertion of a drain after BHT of cSDH significantly reduces the recurrence rate.

- The insertion of a SPD should be encouraged.

- After haematoma irrigation, the cortex surface should be visible; otherwise, membranes need to be carefully perforated.

- Avoid wide opening or removal of membranes, due to the risk of seizures.

- The SPD is placed over both burr holes, without sealing them off, in order to allow communication between the subdural space and the SPD.

- The parietal wound should be closed first, to allow continuous irrigation frontally, preventing pneumocephalus.

- The passive SPD is left in situ for 48 h, and the patients should be kept in a flat position.

- Postoperative CT scans are not routinely performed, and thrombosis prophylaxis is administered on the first postoperative day.

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This article is part of the Topical Collection on Neurosurgery general

Electronic supplementary material

Video showing the drainage of a right-sided chronic subdural haematoma by double burr hole trepanation and the stepwise insertion of a subperiosteal drain (MP4 281,130 kb)

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Ebel, F., Guzman, R. & Soleman, J. Burr hole trepanation and insertion of a subperiosteal drain for chronic subdural haematoma: how I do it. Acta Neurochir 162, 2707–2710 (2020). https://doi.org/10.1007/s00701-020-04442-2

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  • DOI: https://doi.org/10.1007/s00701-020-04442-2

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