Burr hole trepanation and insertion of a subperiosteal drain for chronic subdural haematoma: how I do it
- PDF / 500,075 Bytes
- 4 Pages / 595.276 x 790.866 pts Page_size
- 11 Downloads / 161 Views
HOW I DO IT - NEUROSURGERY GENERAL
Burr hole trepanation and insertion of a subperiosteal drain for chronic subdural haematoma: how I do it Florian Ebel 1
&
Raphael Guzman 1,2,3 & Jehuda Soleman 1,2,3
Received: 20 December 2019 / Accepted: 27 May 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Burr hole trepanation (BHT) is the most commonly used surgical method for the treatment of chronic subdural haematoma (cSDH). Method We give a brief overview on the indication for surgical treatment of cSDH, the surgical technique of BHT, and specific perioperative considerations. In particular, we emphasise on the technique of a subperiosteal drain placement. Conclusion BHT is a valid option to treat chronic subdural haematoma. Careful surgical technique and placement of a subperiosteal drain is required to minimise complications and improve outcome. Keywords Chronic subdural haematoma . Burr hole trepanation . Subperiosteal drainage . Neurosurgery
Relevant surgical anatomy The subdural space is a virtual space between the dura and the arachnoid, which is tethered together by a layer of dural border cells. Due to the absence of tight junctions, the subdural space predisposes to the formation of haematomas [5]. The most common cause for chronic subdural haematoma (cSDH) is a traumatic injury of bridging veins with consecutive venous bleeding. Current evidence suggests that cSDH is caused by neo-membranes formed around the subdural haematoma cavity leading to microbleeds from the fragile neo-capillaries within these This article is part of the Topical Collection on Neurosurgery general Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04442-2) contains supplementary material, which is available to authorized users. * Florian Ebel [email protected] * Jehuda Soleman [email protected] 1
Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
2
Division of Pediatric Neurosurgery, University Children’s Hospital of Basel, Basel, Switzerland
3
Faculty of Medicine, University of Basel, Basel, Switzerland
membranes, reinforced by profibrinolytic and inflammatory factors within the subdural fluid, leading to the maintenance or enlargement of the haematoma [5].
Description of the technique Under general anaesthesia, in a supine position, the head is placed in a horseshoe and rotated to the contralateral side so that the frontal burr hole can be placed at the highest point. This step is important to avoid postoperative pneumocephalus. Prophylactic anticonvulsant medication is not applied routinely, whilst all patients receive a single shot of antibiotics (cefuroxime) 30 min prior to skin incision. Typically, the frontal burr hole is placed over the intersection of the superior temporal line and the coronal suture, and the parietal burr hole is placed above the parietal tuber, approximately 7–8 cm behind the frontal one. Depending on the maximum width of the haematoma, the placement of the burr holes i
Data Loading...
