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  • A Comparison of Single burr hole with closed external drainage system vs Double burr hole with closed external drainage system in the treatment of chronic subdural hematoma – A Series of 230 Cases

    Final Number:

    Rajkumar Raju Pothiraj MCh

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: To analyze, compare and present the effectiveness of Single burrhole with closed external drainage system vs Double burrhole with closed external drainage system in the treatment of chronic SDH

    Methods: In our series, we had 286 cases of chronic SDH from June 2004 to December 2012. Single burrhole or double burrhole with subdural drain connected to closed external drainage system was done for 230 cases. This treatment was offered to patients with CT brain study showing chronic SDH, without septations, without multiple membranes and without acute clots. Remaining 56 cases which don’t meet the above criteria were treated with craniotomy and drainage of hematoma and removal of membranes. Out of 230 patients 54 were bilateral SDH, 176 Unilateral SDH. Single burr hole surgery done in 133 cases and double burr hole surgery in 97 cases.

    Results: More than 75%Radiological reduction of SDH in post-operative CT brain at 48 -72 hrs. was 97.75% for single burrhole surgery and 92.8% for double burrhole surgery. On comparison, single burrhole surgery v/s double burrhole surgery, post-operative pneumocephalus was found in 5.3% v/s 11.34%, fresh acute SDH seen in 4.5% v/s 9.3%. Recollection of SDH with second evacuation surgery within 3 months of first surgery was 3.76% for single burrhole surgery and 13.4% for double burrhole surgery

    Conclusions: Single burrhole with subdural drain offers better results on comparison with double burrhole surgery with subdural drain in the surgical treatment of chronic SDH without septations, multiple membranes and acute clots.

    Patient Care: This study will identify the effective method among the described two modalities of surgical management for Chronic SDH

    Learning Objectives: By the conclusion of this session, participants should be able to describe the importance of single and double burrhole with subdural drain system in the management of chronic subdural hematoma

    References: . 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 Nov;8(6):551-4. 2.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(9):973-4; author reply 974. 3.Taussky P, Fandino J, Landolt H Number of burr holes as independent predictor of postoperative recurrence in chronic subdural haematoma; Br J Neurosurg. 2008 Apr;22(2):279-82 4.Weigel R, Schmiedek P, Krauss JK. Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry. 2003 Jul;74(7):937-43. 5.Gökmen M, Sucu HK, Ergin A, Gökmen A, Bezircio Lu H. Department of Neurosurgery, Izmir Ataturk Research and Training Hospital, Izmir, TurkeyRandomized comparative study of burr-hole craniostomy versus twist drill craniostomy; surgical management of unilateral hemispheric chronic subdural hematomas. Zentralbl Neurochir. 2008 Aug;69(3):129-33. Epub 2008 Jul 29

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