Download PDF
CC BY 4.0 · Indian Journal of Neurotrauma 2023; 20(02): 116-123
DOI: 10.1055/s-0043-1762600
Original Article

Single Frontal Burr-Hole Craniostomy Under Local Anesthesia for Treating Chronic Subdural Hematoma in the Septuagenarians and Older Adults: Surgical Technique and Results

Amos Olufemi Adeleye 
1   Department of Surgery, Division of Neurological Surgery, College of Medicine, University of Ibadan, and University College Hospital, Ibadan, Nigeria
,
Bartholomew I. Ulasi 
2   Department of Surgery, University College Hospital, Ibadan, Nigeria
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Chronic subdural hematoma (CSDH) is not a totally benign disease in the elderly patients, especially those aged 70 years and above. Hence, the surgical treatment of CSDH in aged patients needs to be as minimally disruptive as possible.

Methods An annotated description of the surgical technique of single frontal burr-hole craniostomy performed under local anesthesia and without closed tube drainage for evacuating CSDH in the septuagenarians and older adults is given. We also review the outcome of the procedure on a prospective consecutive cohort of patients in our service

Results Thirty patients, 25 males, aged 70 years and above successfully underwent this surgical procedure. Their mean age was 76.5 years (standard deviation, 4.3). The CSDH was bilateral in 30% (9/30), and more left sided in the rest, the unilateral cases, and was of mixed density radiologically, in most cases (73%, 22/30). Clinical presentation was mainly gait impairment, cognitive decline, and headache, and 57% (17/30) presented with coma or stupor as assessed by the Markwalder grading scale.

The surgery was successfully executed in all, median duration 45.0 minutes (interquartile range 37.3–60.0), and solely under local anesthesia in 77% (23/30) or with momentary short-acting sedation in the rest. The outcome was very good in 90.0% (27/30) using the modified Rankin Scale (mRS) including two-third (20/30) completely asymptomatic (mRS 0) and 7/30 with only slight symptoms/disability, mRS ≤ 2. Three patients died perioperatively, all presenting in coma.

Conclusion This surgical technique appears very effectual for CSDH, is executed at a comparatively low cost, and, being much less disruptive than other traditional methods, may be a more homeostatic operative treatment in geriatric patients at least.

Keywords

chronic subdural hematoma - burr-hole craniostomy - single frontal burr-hole - local anesthesia - geriatric patients

Ethics Approval and Consent to Participate

A letter of request for the audit of the senior author's operative surgical records in this report was stamped approved by the Directorate of Clinical Services, Research and Training of the authors' university teaching hospital, the University College Hospital, Ibadan. Although a reference number was not applicable for this letter of approval, a copy of the letter was uploaded as supplementary material during submission. Each patient or their relatives gave written informed consent for the surgical procedures described in this report


Consent for Publication

Written consent for publication was obtained from the patients whose identifying images are shown in this report.


Authors' Contributions

A.O.A. is responsible for conceptualization, methodology/surgical technique evolution, manuscript drafts through all the stages, project supervision, approval of the submitted version. B.I.U. is responsible for data curation, analysis, manuscript drafts, and approval of the submitted version.


Both the authors have read and approved the manuscript.




Publication History

Article published online:
06 March 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Liu W, Bakker NA, Groen RJ. Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures. J Neurosurg 2014; 121 (03) 665-673
    CrossrefPubMedSearch in Google Scholar
  • 2 Chiappini A, Greuter L, Mariani L, Guzman R, Soleman J. Mortality and outcome in patients older than 80 years of age undergoing burr-hole drainage of chronic subdural hematoma. World Neurosurg 2021; 150: e337-e346
    CrossrefPubMedSearch in Google Scholar
  • 3 Mersha A, Abat S, Temesgen T, Nebyou A. Outcome of chronic subdural hematoma treated with single burr hole under local anesthesia. Ethiop J Health Sci 2020; 30 (01) 101-106
    PubMedSearch in Google Scholar
  • 4 Kitya D, Punchak M, Abdelgadir J, Obiga O, Harborne D, Haglund MM. Causes, clinical presentation, management, and outcomes of chronic subdural hematoma at Mbarara Regional Referral Hospital. Neurosurg Focus 2018; 45 (04) E7
    CrossrefPubMedSearch in Google Scholar
  • 5 Hode L. et al. Treatment and outcome of chronic subdural hematoma in Sub-Saharan Africa and the Country of Benin. Iran J Neurosurg 2015; 1 (02) 31-35
    CrossrefPubMedSearch in Google Scholar
  • 6 Sale D. Single versus double burr hole for drainage of chronic subdural hematoma: randomized controlled study. World Neurosurg 2021; 146: e565-e567
    CrossrefPubMedSearch in Google Scholar
  • 7 Aoki N. Percutaneous subdural tapping for the treatment of chronic subdural haematoma in adults. Neurol Res 1987; 9 (01) 19-23
    CrossrefPubMedSearch in Google Scholar
  • 8 Camel M, Grubb Jr RL. Treatment of chronic subdural hematoma by twist-drill craniotomy with continuous catheter drainage. J Neurosurg 1986; 65 (02) 183-187
    CrossrefPubMedSearch in Google Scholar
  • 9 Miranda LB, Braxton E, Hobbs J, Quigley MR. Chronic subdural hematoma in the elderly: not a benign disease. J Neurosurg 2011; 114 (01) 72-76
    CrossrefPubMedSearch in Google Scholar
  • 10 Mobbs R, Khong P. Endoscopic-assisted evacuation of subdural collections. J Clin Neurosci 2009; 16 (05) 701-704
    CrossrefPubMedSearch in Google Scholar
  • 11 Weigel R, Schmiedek P, Krauss JK. Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry 2003; 74 (07) 937-943
    CrossrefPubMedSearch in Google Scholar
  • 12 Williams GR, Baskaya MK, Menendez J, Polin R, Willis B, Nanda A. Burr-hole versus twist-drill drainage for the evacuation of chronic subdural haematoma: a comparison of clinical results. J Clin Neurosci 2001; 8 (06) 551-554
    CrossrefPubMedSearch in Google Scholar
  • 13 Chen JW, Xu JC, Malkasian D, Perez-Rosendahl MA, Tran DK. The mini-craniotomy for cSDH revisited: new perspectives. Front Neurol 2021; 12: 660885
    CrossrefPubMedSearch in Google Scholar
  • 14 Borger V, Vatter H, Oszvald Á, Marquardt G, Seifert V, Güresir E. Chronic subdural haematoma in elderly patients: a retrospective analysis of 322 patients between the ages of 65-94 years. Acta Neurochir (Wien) 2012; 154 (09) 1549-1554
    CrossrefPubMedSearch in Google Scholar
  • 15 Oyemolade TA, Adeolu AA. Bedside single burr hole craniostomy drainage of chronic subdural hematoma in the emergency room: a useful option in resource challenged settings. Surg Neurol Int 2020; 11: 349
    CrossrefPubMedSearch in Google Scholar
  • 16 Markwalder TM. The course of chronic subdural hematomas after burr-hole craniostomy with and without closed-system drainage. Neurosurg Clin N Am 2000; 11 (03) 541-546
    CrossrefPubMedSearch in Google Scholar
  • 17 Benzel EC, Bridges Jr RM, Hadden TA, Orrison WW. The single burr hole technique for the evacuation of non-acute subdural hematomas. J Trauma 1994; 36 (02) 190-194
    CrossrefPubMedSearch in Google Scholar
  • 18 Hamilton MG, Frizzell JB, Tranmer BI. Chronic subdural hematoma: the role for craniotomy reevaluated. Neurosurgery 1993; 33 (01) 67-72
    PubMedSearch in Google Scholar
  • 19 Ramnarayan R, Arulmurugan B, Wilson PM, Nayar R. Twist drill craniostomy with closed drainage for chronic subdural haematoma in the elderly: an effective method. Clin Neurol Neurosurg 2008; 110 (08) 774-778
    CrossrefPubMedSearch in Google Scholar
  • 20 Escosa Baé M, Wessling H, Salca HC, de Las Heras Echeverría P. Use of twist-drill craniostomy with drain in evacuation of chronic subdural hematomas: independent predictors of recurrence. Acta Neurochir (Wien) 2011; 153 (05) 1097-1103
    CrossrefPubMedSearch in Google Scholar
  • 21 Kidangan GS, Thavara BD, Rajagopalawarrier B. Bedside percutaneous twist drill craniostomy of chronic subdural hematoma-a single-center study. J Neurosci Rural Pract 2020; 11 (01) 84-88
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Shen J, Xin W, Li Q, Gao Y, Zhang J. A grading system for the prediction of unilateral chronic subdural hematoma recurrence after initial single burr hole evacuation. Risk Manag Healthc Policy 2019; 12: 179-188
    CrossrefPubMedSearch in Google Scholar
  • 23 Kenning TJ, Dalfino JC, German JW, Drazin D, Adamo MA. Analysis of the subdural evacuating port system for the treatment of subacute and chronic subdural hematomas. J Neurosurg 2010; 113 (05) 1004-1010
    CrossrefPubMedSearch in Google Scholar
  • 24 Lee JY, Ebel H, Ernestus RI, Klug N. Various surgical treatments of chronic subdural hematoma and outcome in 172 patients: is membranectomy necessary?. Surg Neurol 2004; 61 (06) 523-527 , discussion 527–528
    CrossrefPubMedSearch in Google Scholar
  • 25 Garrett MC, Bilgin-Freiert A, Bartels C, Everson R, Afsarmanesh N, Pouratian N. An evidence-based approach to the efficient use of computed tomography imaging in the neurosurgical patient. Neurosurgery 2013; 73 (02) 209-215 , discussion 215–216
    CrossrefPubMedSearch in Google Scholar
  • 26 Han HJ, Park CW, Kim EY, Yoo CJ, Kim YB, Kim WK. One vs. two burr hole craniostomy in surgical treatment of chronic subdural hematoma. J Korean Neurosurg Soc 2009; 46 (02) 87-92
    CrossrefPubMedSearch in Google Scholar
  • 27 Kansal R, Nadkarni T, Goel A. Single versus double burr hole drainage of chronic subdural hematomas. A study of 267 cases. J Clin Neurosci 2010; 17 (04) 428-429
    CrossrefPubMedSearch in Google Scholar
  • 28 Khadka NK, Sharma GR, Roka YB. et al. Single burr hole drainage for chronic subdural haematoma. Nepal Med Coll J 2008; 10 (04) 254-257
    PubMedSearch in Google Scholar
  • 29 Stanisic M, Lund-Johansen M, Mahesparan R. Treatment of chronic subdural hematoma by burr-hole craniostomy in adults: influence of some factors on postoperative recurrence. Acta Neurochir (Wien) 2005; 147 (12) 1249-1256 , discussion 1256–1257
    CrossrefPubMedSearch in Google Scholar
  • 30 Gazzeri R, Galarza M, Neroni M, Canova A, Refice GM, Esposito S. Continuous subgaleal suction drainage for the treatment of chronic subdural haematoma. Acta Neurochir (Wien) 2007; 149 (05) 487-493 , discussion 493
    CrossrefPubMedSearch in Google Scholar
  • 31 Mondorf Y, Abu-Owaimer M, Gaab MR, Oertel JM. Chronic subdural hematoma—craniotomy versus burr hole trepanation. Br J Neurosurg 2009; 23 (06) 612-616
    CrossrefPubMedSearch in Google Scholar
  • 32 Adeleye AO, Idowu OK, Ghadirpour R, Iaccarino C. Minicraniotomy under local anesthesia and monitored sedation for the operative treatment of uncomplicated traumatic acute extradural hematoma. World Neurosurg 2020; 142: 513-519
    CrossrefPubMedSearch in Google Scholar