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.
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.
related to the operative site:
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.
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.
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.
Anesthesia: Blood clots in the legs, heart attacks,
reaction to the anesthetic, reaction to blood transfusion,
if it given.
There is surprisingly
relatively little pain associated with burr holes.
Your surgeon will prescribe pain medications for any pain
associated with the incision.
upon discharge, contact our office and set up an appointment
for staple removal if one has not already been set up.
- 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.
- 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.
- 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.
- 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.
- Sexual activities
- 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.
- If you have
a seizure, notify our office or come to the emergency
- If you develop
any new weakness, notify our office.
- 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
- If you have
any questions, call our office, and for after hours emergencies,
call the medical society.
- Take your
medications prescribed on discharge, as directed.
- Make sure
to follow up with any other physicians involved in your
care. These may include your family physician, neurologist,
radiation oncologist and oncologist.