Locations of burr holes are associated with recurrence after single burr hole drainage surgery for chronic subdural hematoma

Abstract

AbstractObjectiveThis study aimed to reveal the relation between chronic subdural hematomas (CSDH) recurrence and locations of CSDH and burr holes.MethodsInitial single burr hole surgeries for CSDH with a drainage tube between April 2005 and October 2021 at Otemae Hospital were enrolled. Patients’ medical records, CSDH volume, and CSDH computed tomography values (CTV) were evaluated. The locations of CSDH and burr holes were assessed using Montreal Neurological Institute coordinates.ResultsWe enrolled 223 patients (bilateral CSDH in 34 patients), and 257 surgeries were investigated. Rate of CSDH recurrence requiring reoperation (RrR) was 13.5%. RrR rate was significantly higher in patients aged ≥76 years, bilateral CSDH, and postoperative hemiplegia. In RrR, preoperative CSDH volume was significantly larger, and CTV was significantly smaller. Locations of CSDH had no influence on recurrence. However, in RrR, locations of burr holes were more lateral and more ventral. Multivariate Cox proportional hazards regression analysis showed that bilateral CSDH, more ventral burr hole positions, and postoperative hemiplegia were risk factors for recurrence.ConclusionsLocations of burr holes related to recurrence. In RrR, CSDH profiles had larger volume and less CTV. Hemiplegia after burr hole surgery is a warning sign for RrR.