Outcome of single burr hole under local anesthesia in the management of chronic subdural hematoma

Abstract

Background Management of chronic subdural hematoma (CSDH) is usually surgical; burr hole craniostomy using double burr hole under general anesthesia is the most commonly used technique for its evacuation. However, single burr hole under local anesthesia may be an alternative deserving the study. The aim of this work is to evaluate the prognosis of single burr hole under local anesthesia in the management of CSDH according to the etiology, clinical picture, surgical technique, and prognosis. Patients and methods We studied 67 consecutive patients with CSDH operated by single burr hole craniostomy under local anesthesia from March, 2014, to February, 2015, at Zagazig University Hospitals according to the etiology, clinical picture, surgical technique, and complications. Exclusion criteria were age below 19 years, multilocular hematomas, and uncooperative patients. This is a prospective clinical study. Results The age range was from 19 to 90 years with mean age of 60 years. There were 38 (56.7%) males and 29 (43.3%) females. The main cause of CSDH was old trauma in 43 (64.2%), liver disease in 14 (20.9%), antiplatelet in 8 (11.9%), and ICP hypotension in 2 (3%). Headache was found in 28 (41.8%), disturbed conscious level in 19 (25.4%), hemiparesis in 42 (62.7%), and seizure in 6 (9%). Markwalder scoring for CSDH at time of admission was 3 (4.48%) in grade 0, 20 (29.85%) in grade1, 23 (34.33%) in grade 2, 17 (25.37%) in grade 3, and 4 (5.97%) in grade 4. After evacuation, Markwalder score was 53 (79.01%) in grade 0, 13 (19.4%) in grade 1, 1 (1.50%) in grade 2, 0% in grade 3, and 0% in grade 4. Conclusion Management of chronic subdural hematoma by single burr hole using local anesthesia is safe, effective, and sufficient for patient with unilocular cooperative CSDH patients with short hospital stay, low cost, and lower complication rate. Trial registration ClinicalTrials.gov Identifier: NCT03447327 registered on 26 February 2018. Retrospectively registered.