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Everything about Multiple burr hole

  • Posted on- Jan 06, 2018
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A small opening made inside the bone of the skull to reach intracranial space is called burr hole multiple. It is typically made by some form of spinning burr tool which can either be a manual, electric or pneumatic drill. Incision in small area is like cutting bit, allowing the neurosurgeon for drilling in the skull.

Performing these holes may also be referred to as trephanation or trepanation and evidence of its use dates back into pre-history.

What is the procedure of multiple burr hole?

A burr hole in subdural hematoma performed for the cancelling of hemorrhage out from the surface of brain. Clotting of blood happens under the firm covering of the brain known as the dura mater, and is therefore called subdural hematoma. If the clotting is old, then blood is sent from the small hole inside the skull. 
The patient will be taken to the operating room and put to sleep under general anesthesia. For operation of head, hairs will be removed of that area. The head may simply rest on towels, or it may be placed in three fixation points (Mayfield head pins).

The surgical area for the performance is then "prepped and draped" with the help of antibiotic solution. Next, the surgeon will make an incision, and reflect the scalp over the area of the hematoma. For the hole in the skull, a air drill is used. Then, covering of brain is opened.  The hematoma (blood clot) is now seen, and the surgeon will irrigate some out of it , and may pass a drain around the brain to provide post-operative drainage. The surgeon will then close the scalp.

Why burr hole surgery is done?

Meninges are the layer of thin tissues that surround the brain to protect it and they contain blood vessels. A head injury can tear these blood vessels which lead to continuous bleeding within the brain leading to accumulation of blood just below the “Dura Mater” or “Dura,” (the tough outermost membrane enveloping the brain and spinal cord) which is the outermost layer of the meninges resulting in the formation of subdural hematoma.

The speed at which the blood accumulates depends on the severity of the injury that causes the "subdural hematoma". It can also be caused by the use of anticoagulant medications, small repetitive injuries to the head, consumption of excessive alcohol and age factor.

What are the risks of burr hole surgery?

Generally, all types of surgeries are performed as a last resort because they are associated with some level of risk and sometimes it often leads to permanent injury or even death. The level of risks and problems from surgeries depend on the patient’s age, general health and the cause for surgery.

Risks and complications associated with the burr hole procedure are:

•    Seizures or fits.
•    Further bleeding.
•    Chances of stroke.
•    Skull flap or infection of the incision.
•    COMA
•    Brain inflammation.
•    Deep vein thrombosis that is the blood clot in a leg vein.
•    No relief in the symptoms which can lead to further surgeries such as a craniotomy.
•    Problems from anesthesia.
•    Brain damage which can cause coordination problems, memory issues, and speech impairments.

What is the recovery of burr hole surgery?

Dressing of burr hole is done for 5 days after the surgery without any leakage of cerebra spinal fluid (CSF) after the operation. The time required for recovery from burr hole surgery varies in all the cases, but a child shows faster recovery rate and starts doing well after 6 months of the burr hole procedure.

Good response is showed by many patients and they occupy normal function within a week, so they get a discharge from the hospital in 1 to 2 weeks but some patients remain unconscious after the burr hole procedure and they have to be treated in the ICU until they start performing the normal functions properly post burr hole surgery.

Minimum cost of burr hole multiple is Rs.2,30,000 to maximum Rs.4,60,000.


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