Chronic Subdural Hematoma Drainage (Burr Hole)
Chronic subdural hematoma drainage is a surgical procedure in which old blood that has collected over time between the brain and the dura is evacuated through a small hole drilled in the skull (burr hole). It is performed particularly in elderly patients to relieve symptoms caused by compression.
Përditësimi i fundit: 2026-06-09
Definition
A chronic subdural hematoma is a partly liquefied collection of blood that slowly accumulates in the subdural space, usually over weeks, and can compress the brain tissue. Burr hole drainage is a technique in which this collection is evacuated through one or more small holes drilled in the skull. The aim of the procedure is to relieve the pressure created by the hematoma and to resolve neurological symptoms. The method is a widely used and relatively less invasive approach in the surgical treatment of chronic subdural hematoma.
Indications
Burr hole drainage is considered in patients with a chronic subdural hematoma of significant size or with mass effect, demonstrated on imaging (usually CT) and concordant with clinical findings. The presence of symptoms such as headache, confusion, gait and balance disturbance, or weakness in an arm or leg supports the decision for surgery. Advanced age, a history of minor head trauma, and use of blood-thinning medication are common predisposing factors for this hematoma. Small, asymptomatic collections may in some cases be managed with close observation rather than surgery; the decision is based on the size of the hematoma, the symptoms, and the patient's general condition.
Procedure
The procedure may be performed under general or local anesthesia; the patient is positioned supine with the head turned according to the side of the hematoma. After a small incision in the scalp, one or more burr holes are drilled in the skull and the dura is carefully opened. The liquefied hematoma is evacuated and the subdural space is usually gently irrigated with saline. In most cases a temporary drainage catheter is placed to remove residual fluid and reduce reaccumulation. The dura and tissue layers are closed; the drain is usually removed after a short period, and follow-up imaging may be performed.
Advantages and Limitations
Burr hole drainage is a relatively quick method, considered less invasive than larger craniotomies and feasible even in elderly patients, with extensive clinical experience. In most cases it can provide marked improvement in symptoms. However, reaccumulation of the hematoma (recurrence) is a known event that can occur after this procedure, and some patients may require a repeat intervention. In multiloculated (septated), thick-membraned, or solid hematomas it may be insufficient alone and a more extensive surgery may be needed. The use of blood-thinning medication and comorbidities influence management.
Recovery and Risks
Recovery varies from patient to patient; many patients may experience relatively rapid improvement in their symptoms, but advanced age and comorbidities can prolong the process. Possible risks include reaccumulation of the hematoma, bleeding (including new or acute subdural hemorrhage), infection, seizures, and rarely failure of the brain tissue to re-expand. Symptoms may not resolve completely or may partly persist. No outcome is guaranteed; the decision is individualized by considering the patient's clinical status, imaging findings, comorbidities, and expectations together.
Burimet
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1082-1085.
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011:533-542.
- Santarius T, et al. Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet. 2009.
Ky artikull ka karakter të përgjithshëm informues dhe nuk zëvendëson vizitën mjekësore. Vendimet për diagnozën dhe trajtimin janë individuale.