Number of burr holes as independent predictor of postoperative recurrence in chronic subdural haematoma

Taussky, Philipp; Fandiño, Javier; Landolt, Hans

doi:10.1080/02688690701818885

Cited by 98 publications

(86 citation statements)

References 26 publications

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“…Therefore, two burrhole craniostomy is more efficient to flush out subdural fluid collections. 14,15,21) The two burr-hole method maintains the open condition by design, because the other route is secured by the second burr hole (Fig. 2).…”

Section: Discussionmentioning

confidence: 99%

“…7,21,23) Craniotomy is generally not performed because of the invasiveness of the procedure. Craniostomy is the main method of surgical treatment, 23) and is performed by twist drill craniostomy (diameter less than 5 mm), 6,7,13,19,23) one burr-hole craniostomy (8-15 mm), 5,7,18,20) and two burr-hole craniostomy.…”

Section: Introductionmentioning

confidence: 99%

“…Craniostomy is the main method of surgical treatment, 23) and is performed by twist drill craniostomy (diameter less than 5 mm), 6,7,13,19,23) one burr-hole craniostomy (8-15 mm), 5,7,18,20) and two burr-hole craniostomy. 15,21) Twist drill craniostomy was introduced as a less invasive method for the treatment of CSDH, and is used worldwide. 13,19) The two burr-hole method is also widely used, 15,21) and was introduced to achieve sufficient irrigation, which could reduce the rate of recurrence of CSDH.…”

Section: Introductionmentioning

confidence: 99%

“…15,21) Twist drill craniostomy was introduced as a less invasive method for the treatment of CSDH, and is used worldwide. 13,19) The two burr-hole method is also widely used, 15,21) and was introduced to achieve sufficient irrigation, which could reduce the rate of recurrence of CSDH. 3,12) One burr-hole craniostomy with or without irrigation may be the most important surgical method and the most widely used in Japan.…”

Section: Introductionmentioning

confidence: 99%

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Critical Classification of Craniostomy for Chronic Subdural Hematoma; Safer Technique for Hematoma Aspiration

Tosaka

Sakamoto²,

Watanabe³

et al. 2013

Neurol. Med. Chir.(Tokyo)

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Chronic subdural hematoma (CSDH) is generally treated by twist drill, and one and two burr-hole craniostomy. We proposed new classification of the intraoperative condition of CSDH, and present a safer technique for aspiration of CSDH in one burr-hole surgery. The intraoperative condition of CSDH was classified according to the connections between the hematoma cavity and the extracranial space as follows. The``closed condition'' represents only a single route consisting of a tube inserted intraoperatively connecting the extracranial space to the hematoma cavity. The``open condition'' includes another route or space, which can freely pass air, saline, or old hematoma fluid, in addition to the tube inserted intraoperatively. Twist drill craniostomy and two burr-hole craniostomy clearly involve the intraoperative closed and open conditions, respectively. One burr-hole craniostomy may involve either condition due to the operative procedure. Aspiration and irrigation of the hematoma is basically free and safe in the open condition, but risky in the closed condition. All of the hematoma can be aspirated through one burr hole under certain open conditions with temporary replacement of the hematoma cavity with air followed by replacement of air with saline. Twenty-seven patients with symptomatic CSDH underwent one burr-hole craniostomy by the above mentioned aspiration technique. There were no special complications. The recurrence rate was average. The substitution of saline after complete aspiration of hematoma carries little risk only under the``open condition,'' shortens the operation time, and achieves good irrigation of the hematoma.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Critical Classification of Craniostomy for Chronic Subdural Hematoma; Safer Technique for Hematoma Aspiration

Tosaka

Sakamoto²,

Watanabe³

et al. 2013

Neurol. Med. Chir.(Tokyo)

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“…2,14,26 The effectiveness of various surgical techniques (including bur hole craniostomy alone, bur holes with subdural drains, bedside twist drill craniostomy with drain placement, and formal craniotomy) have been extensively evaluated. 5,6,10,15,20,21,31,33 Variations of each of these techniques have also been studied, including the duration of subdural drainage, 32 location of the subdural catheter after bur hole drainage, 22 the number of bur holes, 24 bur holes with passive subperiosteal drainage system, 33 and the position of the head after bur hole placement 1 or twist-drill treatment.…”

Section: Discussionmentioning

confidence: 99%

Minicraniotomy versus bur holes for evacuation of chronic subdural collections in infants—a preliminary single-institution experience

Klimo

Matthews

Lew

et al. 2011

PED

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Object Various surgical interventions have been described to evacuate chronic subdural collections (CSCs) of infancy. These include transfontanel percutaneous aspiration, subdural drains, placement of bur hole(s) with or without a subdural drain, and shunting. Shunt placement typically provides good long-term success (resolution of the subdural fluid), but comes with well-known early and late complications. Recently, the authors have used a mini–osteoplastic craniotomy technique with the goal of definitively treating these children with a single surgery while avoiding the many issues associated with a shunt. They describe their procedure and compare it with the traditional bur hole technique. Methods In this single-institution retrospective study, the authors evaluated 26 cases involving patients who underwent treatment for CSC. Preoperative, intraoperative, and postoperative data were reviewed, including radiographic findings (density of the subdural fluid and ventricular and subarachnoid space size), neurological examination findings, and intraoperative fluid description. The primary outcome was treatment failure, defined as the patient requiring any subsequent surgical intervention after the index procedure (minicraniotomy or bur hole placement). Results Fifteen patients (10 male and 5 female; median age 5.1 months) collectively underwent 27 minicraniotomy procedures (each procedure representing a hemisphere that was treated). In the bur hole group, there were 11 patients (6 male and 5 female; median age 4.6 months) with 18 hemispheres treated. Both groups had subdural drains placed. The average follow-up for each treatment group was just over 7 months. Treatment failure occurred in 2 patients (13%) in the minicraniotomy group compared with 5 patients (45%) in the bur hole group (p = 0.09). Furthermore, the 2 patients who had treatment failure in the minicraniotomy group required 1 subsequent surgery each, whereas the 5 in the bur hole group needed a total of 9 subsequent surgeries. Eventually, 80% of the patients in the minicraniotomy group and 70% of those in the bur hole group had resolution of the subdural collections on the last imaging study. Conclusions The minicraniotomy technique may be a superior technique for the treatment of CSCs in infants compared with bur hole evacuation. The minicraniotomy provides greater visualization of the subdural space and allows more aggressive evacuation of the fluid, better irrigation of the space, the ability to fenestrate any accessible membranes safely, and continued egress of fluid into the subgaleal space. Although this preliminary report has obvious limitations, evaluation of this technique may be worthy of a prospective, multiinstitutional collaborative effort.

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Prediction of in-hospital mortality and morbidity using high-sensitivity C-reactive protein after burr hole craniostomy

et al. 2016

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Number of burr holes as independent predictor of postoperative recurrence in chronic subdural haematoma

Cited by 98 publications

References 26 publications

Critical Classification of Craniostomy for Chronic Subdural Hematoma; Safer Technique for Hematoma Aspiration

Critical Classification of Craniostomy for Chronic Subdural Hematoma; Safer Technique for Hematoma Aspiration

Minicraniotomy versus bur holes for evacuation of chronic subdural collections in infants—a preliminary single-institution experience

Prediction of in-hospital mortality and morbidity using high-sensitivity C-reactive protein after burr hole craniostomy

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