Comparison of One Versus Two Burr Hole Procedures in Evacuation of Chronic Subdural Hematoma

Authors

  • Babar Shamim Department of Neurosurgery Combined Military Hospital /National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Ahmed Tashfeen Ashraf Department of Neurosurgery Combined Military Hospital /National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Muhammad Junaid Mushtaq Department of Neurosurgery Combined Military Hospital /National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Khurshid Ali Bhangash Department of Neurosurgery Combined Military Hospital /National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Awais Ali Khan Department of Neurosurgery, Combined Military Hospital Tarbela/National University of Medical Sciences (NUMS) Pakistan
  • Memoona Ejaz Department of Neurosurgery Combined Military Hospital /National University of Medical Sciences (NUMS) Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74i1.4002

Keywords:

Burr holes procedure, Chronic subdural hematoma, Hematoma, Length of stay

Abstract

Objective: To compare the two techniques of chronic subdural hematoma evacuation, i.e. one burr hole versus two burr holes, in terms of recurrence and duration of hospital admission.

Study Design: Quasi-experimental study

Place and Duration of Study: Department of Neurosurgery, Combined Military Hospital Rawalpindi Pakistan, from Aug to Dec 2019.

Methodology: Two hundred twenty-eight patients with chronic subdural hematoma were recruited for this study and equally distributed into two groups. In the One-Burr Hole Group, all patients were operated by a single burr hole drilled via a pneumatic burr in the parietal bone on the affected side. In contrast, in the Two-Burr Hole Group, all patients were subjected to two burr holes, with one burr hole made in the parietal bone and the second burr hole in the frontal bone on the affected side.

Results: Patients 14(12.28%) with two burr hole procedures significantly (p=0.001) recurred less than patients 27(23.68%) who were subjected to One Burr Hole treatment. The mean hospital stay (days) for Two-Hole Burr Group (Mean=9.00± 2.00) was significantly less than One-Hole Burr Group (Mean=14.00±3.00). However, operation time (minutes) on average for patients that were subject to Two-Hole Burr (Mean=110.00±7.00) procedure was significantly (p-0.001) longer than One-Hole Burr
(Mean= 96.00 ±6.00) patients.

Conclusion: It is better to evacuate the chronic subdural hematoma using a two burr holes procedure as the rate of recurrence, and the hospital stay are less as compared to the single burr hole technique.

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References

Lee KS. History of Chronic Subdural Hematoma. Korean J

Neurotrauma 2015; 11(2): 27-34.

https://doi.org/10.13004/kjnt.2015.11.2.27.

Rauhala M, Luoto TM, Huhtala H, Iverson GL, Niskakangas T,

Öhman J, et al. The incidence of chronic subdural hematomas

from 1990 to 2015 in a defined Finnish population. J Neurosurg

; 132(4): 1147-1157.

https://doi.org/1010.3171/2018.12.JNS183035.

Achakzai N, Adil I, Khan S. Outcome of surgical management of

chronic subdural hematoma. Pak J Neurol Surg 2018; 22(2): 61-

Jeong SI, Kim SO, Won YS, Kwon YJ, Choi CS. Clinical Analysis

of Risk Factors for Recurrence in Patients with Chronic Subdural

Hematoma Undergoing Burr Hole Trephination. Korean J

Neurotrauma 2014; 10(1): 15-21.

https://doi.org/10.13004/kjnt.2014.10.1.15.

Yadav YR, Parihar V, Namdev H, Bajaj J. Chronic subdural

hematoma. Asian J Neurosurg 2016; 11(4): 330-342.

https://doi.org/10.4103/1793-5482.145102.

Lee HS, Song SW, Chun YI, Choe WJ, Cho J, Moon CT, et al.

Complications following burr hole craniostomy and closedsystem drainage for subdural lesions. Korean J Neurotrauma

; 14(2): 68-75.

Lee KS. How to Treat Chronic Subdural Hematoma? Past and

Now. J Korean Neurosurg Soc 2019; 62(2): 144-152.

https://doi.org/10.3340/jkns.2018.0156.

Teasdale G, Jennett B. Assessment of coma and impaired

consciousness. A practical scale. Lancet 1974; 2(7872): 81-84.

https://doi.org/10.1016/s0140-6736(74)91639-0.

Khan ZM, Islam M, Khokhar TI, Majid HA. Recurrence of CSHD

after single burr-hole evacuation and closed drainage system

versus double burr hole evacuation and closed drainage system.

Pak J Neurol Surg 2018; (22)4: 166-172.

Khan HU, Atif K, Boghsani GT. Single versus double burr-hole

drainage for chronic subdural hematoma: A study of relevant

prognostic factors conducted in Pakistan. Pak J Med Sci 2019;

(4): 963-968. https://doi.org/10.12669/pjms.35.4.543.

Taussky P, Fandino J, Landolt H. Number of burr holes as

independent predictor of postoperative recurrence in chronic

subdural haematoma. Br J Neurosurg 2008; 22(2): 279-282.

https://doi.org/10.1080/02688690701818885.

Coulter IC, Pesic-Smith JD, Cato-Addison WB, Khan SA,

Thompson D, Jenkins AJ, et al. Routine but risky: a multi-centre

analysis of the outcomes of cranioplasty in the Northeast of

England. Acta Neurochir 2014; 156(7): 1361-1368.

https://doi.org/10.1007/s00701-014-2081-1.

Joswig H, Gautschi OP, El Rahal A, Sveikata L, Bartoli A,

Hildebrandt G, et al. Cranioplasty: Is Surgical Education Safe?

World Neurosurg 2016; 91: 81-88.

https://doi.org/10.1016/j.wneu.2016.03.081.

Phan K, Moore JM, Griessenauer C, Dmytriw AA, Scherman DB,

Sheik-Ali S, et al. Craniotomy Versus Decompressive

Craniectomy for Acute Subdural Hematoma: Systematic Review

and Meta-Analysis. World Neurosurg 2017; 101: 677-685.e2.

https://doi.org/10.1016/j.wneu.2017.03.024.

van Middelaar T, Nederkoorn PJ, van der Worp HB, Stam J,

Richard E. Quality of life after surgical decompression for spaceoccupying middle cerebral artery infarction: systematic review.

Int J Stroke 2015; 10(2): 170-176.

https://doi.org/10.1111/ijs.12329.

Honeybul S, Ho KM, Gillett GR. Reconsidering the role of

decompressive craniectomy for neurological emergencies. J Crit

Care 2017; 39: 185-189.

https://doi.org/10.1016/j.jcrc.2017.03.006.

Zanaty M, Chalouhi N, Starke RM, Clark SW, Bovenzi CD, Saigh

M, et al. Complications following cranioplasty: incidence and

predictors in 348 cases. J Neurosurg 2015; 123(1): 182-188.

https://doi.org/10.3171/2014.9.JNS14405.

Bobinski L, Koskinen LO, Lindvall P. Complications following

cranioplasty using autologous bone or polymethylmethacrylate--

retrospective experience from a single center. Clin Neurol

Neurosurg 2013; 115(9): 1788-1791.

https://doi.org/10.1016/j.clineuro.2013.04.013.

Wachter D, Reineke K, Behm T, Rohde V. Cranioplasty after

decompressive hemicraniectomy: underestimated surgeryassociated complications? Clin Neurol Neurosurg 2013; 115(8):

-1297. https://doi.org/10.1016/j.clineuro.2012.12.002

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Published

28-02-2024

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Original Articles

How to Cite

1.
Shamim B, Ahmed Tashfeen Ashraf, Mushtaq MJ, Khurshid Ali Bhangash, Awais Ali Khan, Memoona Ejaz. Comparison of One Versus Two Burr Hole Procedures in Evacuation of Chronic Subdural Hematoma. Pak Armed Forces Med J [Internet]. 2024 Feb. 28 [cited 2024 Nov. 22];74(1):121-4. Available from: https://pafmj.org/PAFMJ/article/view/4002