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Burr hole : Subdural Hematoma

Procedure description

A burr hole  for subdural hematoma is performed to remove a hemorrhage (blood clot) from around the surface of the brain.  The location of the blood clot is beneath the firm covering of the brain known as the dura mater, and is therefore called subdural hematoma.  Generally, when a blood clot is moderately old (at least two to three weeks), it may  be drained through a small hole in the skull, and a large craniotomy flap (opening in the skull) might be avoided. 

The patient will be taken to the operating room and put to sleep under general anesthesia.  The head will be partially shaved, to expose the area of operation.  The head may simply rest on towels, or it may be placed in three fixation points (Mayfield head pins).    The area where surgery is to be performed is then "prepped and draped" using an antibiotic solution.  Next, the surgeon will make an incision, and reflect the scalp over the area of the hematoma.  Then, an air powered drill is used to make a hole in the skull.  The dura mater (tough covering of the brain) is then opened.  The hematoma (blood clot) is now seen, and the surgeon will irrigate some of it out, and may pass a drain around the brain to provide post-operative drainage.  The surgeon will then close the scalp. 

 

Procedure Risks

Burr hole for subdural hematoma is a common procedure for surgeons.  Risks  can be broken down into two categories, 1) those related to the operative site, and 2) those related to the risks of anesthesia. 

Risks related to the operative site: 

Surgical Exposure: The patient is placed in a supine position (on their back).    There is risk of non healing of the scalp  post operatively.  Although very uncommon, there can be injury to or tearing of the scalp from the pins on the Mayfield clamp. 

Brain injury: The surgery involves exposure of the surface of the brain.  There is the possibility that there may be injury to the brain.  If so, this could result in weakness, seizures, stroke, paralysis, coma or death.  There may be residual fluid or blood, requiring additional surgery in the future.  If the fluid around the brain is loculated in pockets separated by membranes, then the surgery will be unlikely to remove all the fluid, and may in fact only remove a small portion.  This would necessitate additional surgery, possibly a larger craniotomy to remove the membranes and blood. 

General Risks: These include such general difficulties, such as bleeding, infection, stroke, paralysis, coma and death.  Incisions on the low back generally heal well, but if could   be tender, or may heal in an unpleasant manner.  There is also the possibility that the surgery may not relieve the symptoms for which the procedure was performed.  The problem for which the surgery was performed may recur, requiring additional surgery in the future.  In addition, although every attempt is made to protect all areas of the body from pressure on nerves, skin and bones, injuries to these areas can occur, particularly with prolonged cases.

Risks of Anesthesia: Blood clots in the legs, heart attacks, reaction to the anesthetic, reaction to blood transfusion, if it given.

 

Post-operative care:

There is surprisingly relatively little pain associated with burr holes.  Your surgeon will prescribe pain medications for any pain associated with the incision. 

  1. Immediately upon discharge, contact our office and set up an appointment for staple removal if one has not already been set up.
  2. Take it easy until seen by the physician.  This does not mean bed rest, but athletic activities during this period are definitely not recommended.  Please give your incision a chance to heal.  Avoid any type of activity which might risk a blow to the head.
  3. You may resume activity as your body permits, but avoid extremes.  For example, walking is fine, but avoid any strenuous running.  USE GOOD JUDGMENT  AND COMMON SENSE.  If you have a question, ask your doctor.
  4. No driving until cleared with your surgeon.  A driving test may be required, at the discretion of your surgeon.  Even though you may feel fine, your peripheral vision and reflexes may have been affected, and we want you to be safe on the road for yourself as well as for others.
  5. You may shower after you go home unless otherwise instructed.  Cover the incision with plastic wrap before the shower and remove it afterward.  Change dressing immediately.    You may shower without covering the incision one week after the staples are out.  Follow instructions concerning care of tapestrips, stitches or staples.  Your surgeon or his nurse clinician will explain the techniques used in the closure of your incision.
  6. Sexual activities are permitted.
  7. If you notice swelling, redness or opening of the incision, or if there is any clear fluid draining from it, please contact your surgeon immediately!  If you develop a fever, stiff neck or chills, contact the office immediately.  Take your temperature at 4:00 PM daily until the clips are removed.  Call if greater than 101 degrees Fahrenheit.
  8. If you have a seizure, notify our office or come to the emergency room.
  9. If you develop any new weakness, notify our office.
  10. If you have any paralysis or weakness, post-operative care will need to be tailored to this.  If a brace for an arm of a leg has been prescribed, use it as recommended by your surgeon.
  11. If you have any questions, call our office, and for after hours emergencies, call the medical society.
  12. Take your medications prescribed on discharge, as directed.
  13. Make sure to follow up with any other physicians involved in your care.  These may include your family physician, neurologist, radiation oncologist and oncologist.

 

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