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28.08.2018 | Original Article - Neurosurgical technique evaluation | Ausgabe 11/2018 Open Access

Acta Neurochirurgica 11/2018

Improving the aesthetic outcome with burr hole cover placement in chronic subdural hematoma evacuation—a retrospective pilot study

Zeitschrift:
Acta Neurochirurgica > Ausgabe 11/2018
Autoren:
Flavio Vasella, Kevin Akeret, Nicolas R. Smoll, Menno R. Germans, Elisabeth Jehli, Oliver Bozinov, Luca Regli, Martin N. Stienen, on behalf of the CORRECT SCAR study group
Wichtige Hinweise
Flavio Vasella and Kevin Akeret contributed equally to this work.
This article is part of the Topical Collection on Neurosurgical technique evaluation

Abstract

Background

The aesthetic outcome after burr hole trepanation for the evacuation of chronic subdural hematomas (cSDH) is often unsatisfactory, as the bony skull defects may cause visible skin depressions. The purpose of this study was to evaluate the efficacy of burr hole cover placement to improve the aesthetic outcome.

Methods

We reviewed consecutive patients treated by burr hole trepanation for cSDH with or without placement of burr hole covers by a single surgeon between October 2016 and May 2018. The clinical data, including complications, were derived from the institution’s prospective patient registry. The primary endpoint was the aesthetic outcome, as perceived by patients on the aesthetic numeric analog (ANA) scale, assessed by means of a standardized telephone interview. Secondary endpoints were skin depression rates and wound pain, as well as complications.

Results

From n = 33, outcome evaluation was possible in n = 28 patients (n = 24 male; mean age of 70.4 ± 16.1 years) with uni- (n = 20) or bilateral cSDH (n = 8). A total of 14 burr hole covers were placed in 11 patients and compared to 50 burr holes that were not covered. Patient satisfaction with the aesthetic outcome was significantly better for covered burr holes (mean ANA 9.3 ± 0.74 vs. 7.9 ± 1.0; p < 0.001). Skin depressions occurred over 7% (n = 1/14) of covered and over 92% (n = 46/50) of uncovered burr holes (p < 0.001). There was no difference in wound pain (p = 0.903) between covered and uncovered sites. No surgical site infection, cSDH recurrence, or material failure was encountered in patients who had received a burr hole plate.

Conclusions

In this retrospective series, placement of burr hole covers was associated with improved aesthetic outcome, likely due to reduction of skin depressions. A randomized controlled trial is developed to investigate whether adding burr hole covers results in superior aesthetic outcomes, without increasing the risk for complications.

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