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Chronic subdural hematoma under local anesthesia with manual burr hole

  • How I Do it - Brain trauma
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Abstract

Context

Burr hole evacuation (BHE) of symptomatic chronic subdural hematoma (CSH) carries significant morbidity and mortality in the elderly because they are a fragile population. As military neurosurgeons, we perform a simplified technique under local anesthesia using a manual craniotome.

Methods

We present the case of an 85-year-old woman suffering from a right-sided CSH causing confusion and severe left-sided hemiparesis.

Conclusion

After the procedure, the patient presented immediate neurological improvement. Performing manual BHE of symptomatic CSH under local anesthesia is safe, and it is of great interest for very old patients or in case of strained resources, thus we think that this technique should be taught to every young neurosurgery resident.

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References

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Author information

Authors and Affiliations

  1. Neurosurgery Department, Sainte-Anne Military Teaching Hospital, 2 boulevard Sainte-Anne, 83800, Toulon Cedex 9, France

    Nathan Beucler, Aurore Sellier, Cédric Bernard & Arnaud Dagain

  2. Ecole du Val-de-Grâce, French Military Health Service Academy, 1 place Alphonse Laveran, 75230, Paris Cedex 5, France

    Nathan Beucler

  3. Val-de-Grâce Military Academy, 1 place Alphonse Laveran, 75230, Paris Cedex 5, France

    Arnaud Dagain

Authors
  1. Nathan Beucler
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  2. Aurore Sellier
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  3. Cédric Bernard
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  4. Arnaud Dagain
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Contributions

NB and AD conceptualized the article.

NN, AS, CB, and AD participated to the clinical care of the patient.

NN, AS, CB, and AD participated to the drafting of the manuscript.

NN, AS, CB, and AD participated to the literature review.

NN, AS, CB, and AD participated to the critical revision of the manuscript.

NB and AD participated to the final revision of the manuscript.

The pencil drawings were performed by N. Beucler.

Corresponding author

Correspondence to Nathan Beucler.

Ethics declarations

Patient informed consent

The patients who appear in the photographs and surgical video have been given the possibility to read the manuscript and have consented to the publication of this work.

This work has been conducted in accordance with the Declaration of Helsinki 1964 and its further amendment in 2013.

Competing interests

The authors declare no competing interests.

Additional information

Take home messages

1. Manual burr hole evacuation under local anesthesia is useful in very old patients and strained resource facilities

2. Open discussion with the patient, the anesthesiology team, and the circulating nurse before the procedure is essential

3. Identify carefully the incision landmarks (linea temporalis, coronal suture)

4. A thorough local anesthesia is very important

5. Try not to waste time during manual cranial drilling

6. Dura mater coagulation and incision is painful

7. Be attentive to the patient’s reaction after the sudden release of intracranial pressure

8. Fill the subdural space with water before closing the wound

9. Anticipate drain removal with a purse string suture

10. Talk to your patient during the whole procedure

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This article is part of the Topical Collection on Brain trauma

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Beucler, N., Sellier, A., Bernard, C. et al. Chronic subdural hematoma under local anesthesia with manual burr hole. Acta Neurochir 163, 1837–1841 (2021). https://doi.org/10.1007/s00701-021-04818-y

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  • DOI: https://doi.org/10.1007/s00701-021-04818-y

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