Inner membrane opening during the burr-hole evacuation of a chronic subdural hematoma: risk-adding or recurrence-preventing?

Abstract

Background: Chronic subdural hematoma (CSDH) is a common situation in neurosurgical practice. Only a few studies had mentioned the opening of the inner membrane during the burr-hole evacuation of a CSDH. This study was designed to assess the benefits of inner membrane opening in the burr-hole evacuation of a CSDH and to find out if there is an added risk of such step that overweighs its benefits. Methods: This is a descriptive cohort study that retrospectively reviewed 81 patients who underwent CSDH evacuation in Ain Shams University hospitals from October 2007 to August 2017. Results: There were 54 (66.7%) males and 27 (33.3%) females. Age ranged from 40 to 84 years with a mean age of 64. 95 years. The mean of maximum hematoma thickness measured in the preoperative brain CT scan was 22.58 mm ranging from 12 to 42 mm. Preoperative midline shift ranged from 0 to 21 mm with a mean value of 10.65 mm. All patients had an adequate radiological evacuation of the CSDH and did not develop a new acute subdural hematoma or intracerebral hematoma. The mean follow-up duration was 16.77 months (ranging from 3 to 60 months). There were 3 patients (3.7%) complicated with a recollection of subdural blood that required a second surgery. Included patients neither had postoperative cerebrospinal fluid leakage nor subdural empyema. Conclusions: It can be concluded that this operative step was not a risk-adding but, apparently, a recurrencepreventing one. However, a prospective randomized controlled study is recommended to establish this finding.

Minimal Invasive Retrosigmoidal Parasterional Burr-Hole Approach: Technique and Neuropathic Pain Amelioration after Microvascular Decompression of the Trigeminal Nerve

“…26 For this reason, it was decided to refer to this technique as a Retrosigmoid/Para-asterional burr hole, because the description of a burr hole has an average size of a dime (approximately 17.9 mm), the same dimensions used in the patients included in the present study (18 mm). 27 TN is a high incidence pathology, and with high health costs. MVD of the trigeminal nerve is established as a therapeutic strategy, with complete resolution of symptoms and low remission in 10 years follow up 12 .…”

Minimally Invasive Retrosigmoidal Parasterional Burr-Hole Approach: Technique and Neuropathic Pain Amelioration after Microvascular Decompression of the Trigeminal Nerve

“…However, a craniectomy is not an adequate term for the procedure, because an article that evaluates the trephinations, trephines, and craniectomies found that "craniectomy" is a term used to refer to a huge cranial opening or window of variable shape that may include a size bigger than 4 cm that corresponds to the size of a trepan [27]. For this reason, it was decided to refer to this technique as a retrosigmoid parasterional burr-hole, because the description of a burr-hole has an average size of a dime (approximately 17.9 mm), the same dimensions used in the patients included in the present study (18 mm) [28].…”

Controversies in the Surgical Treatment of Chronic Subdural Hematoma: A Systematic Scoping Review

“…Another study by Elayouty et al was based on performing BHC with restricted membranectomy. The authors reported that adding membranectomy to BHC reduces the risk of recurrence [ 81 ]. Sahyouni et al conducted a meta-analysis of 17 cohort studies, showing that craniotomy with the excision of membranes is related to a lower recurrence risk but similar mortality and morbidity rates when compared to the literature rates for craniotomies without membranectomy [ 82 ].…”