Burr Hole

What is a Burr Hole?

The clinical term “burr hole” refers to a surgical operation where neurosurgeons produce a small hole in your skull ¹. This hole helps to relieve pressure on the brain when fluids, like blood, build up and compresses the brain tissue. This builds up of blood eventually can lead to death while left untreated.

Usually, meninges, a layer of thin tissues surrounds and protects the brain. These meninges contain tiny blood vessels that supply blood to and from the brain. But a head injury results in the tear of these blood vessels and bleeding occurs. An immediate, sudden rupture might cause blood to build up very quickly. In contrast, a small tear cause blood to build up more slowly. This blood builds up just below the dura mater, the outer covering of meninges. This condition results in a subdural hematoma ².

Like other surgical operations, burr hole surgery comprises some risks during and after operation. Complications arises after a burr hole surgery include excessive bleeding, infection, the formation of a blood clot, brain injury, heart attack or stroke, problems with anesthesia, etc. These risks may vary according to the patient’s age, overall health condition, and the reason for this procedure. Your healthcare provider will determine the potential risks before the operation.

What types of neurological conditions do Neurosurgeons utilize a Burr Hole?

A burr hole mostly used during brain surgery and treating a brain condition called a subdural hematoma. In order to access the brain tissue, surgeons will open the skull to get access to the brain. For this reason, most brain surgery requires to place a hole in the skull to treat the injury or illness. There’s a lot of condition for which surgeons require a burr hole to perform brain surgery ³. These conditions include acute and chronic subdural hematoma, epidural hematoma,hydrocephalus, removing abscess around the meninges, removing a blood clot, removing a brain tumor, or any foreign object, relieving pressure from the brain, etc. Also, we can use burr hole-

• To treat seizures
• To begin a craniotomy operation
• To drain blood after a traumatic injury from the brain
• To place a monitor inside the brain
• To place any object or medical devices, such as a shunt or chemotherapy wafers

Burr hole creates a gateway from where your surgeon can get access to enter and guide their instruments to the brain. Most operation requires to make several burr holes to allow surgeons to access a wider area of the brain ¹.

How do Neurosurgeons Perform a Burr Hole?

The Burr Hole surgery requires a well-trained neurosurgeon, a neurologist, an anesthesiologist, and a nursing assistant to perform successfully. A neurosurgeon will map out your brain by using diagnostic tools where exactly the burr hole needs to make. After the neurosurgeon determines the suitable location, the process starts. The general steps include ⁴:

1. You need to lie on your stomach on the operation table with pillows supporting each side of the body.
2. Surgeon will perform general anesthesia to make the patient sleep so that you will not feel any pain or sensation. Here, you will also have a catheter during the operation.
3. Your surgeon will shave and remove the hair of the area and give a small incision in the scalp to expose your skull.
4. Your surgeon will use a special drill to insert the burr hole into the skull.
5. Surgeons will use this hole to drain blood or other fluid causing pressure on the brain.
6. Finally, your surgeon will close this hole or left it open with a drain or shunt attached.

After this operation, you’ll move to the recovery place and stay in the hospital for 1 or 2 days. Nurses will monitor your condition during these days to make sure no complications arise. A regular course of antibiotics will prevent any post-surgical infections in the surgical site. Talk to your surgeon in case of any post-surgical abnormalities.

References

1. Yuan, Y. et al. Burr hole drainage and burr hole drainage with irrigation to treat chronic subdural hematoma: A systematic review and meta-analysis. Med. (United States) 97, (2018).
2. Fatigba, H. O. et al. The Exploratory Burr Hole: Indication and Results at One Departmental Hospital of Benin. ISRN Surg. 2013, 1–4 (2013).
3. Májovský, M., Netuka, D., Beneš, V. & Kucera, P. Burr-hole evacuation of chronic subdural hematoma: Biophysically and evidence-based technique improvement. J. Neurosci. Rural Pract. 10, 113–118 (2019).
4. Salama, H. Outcome of single burr hole under local anesthesia in the management of chronic subdural hematoma. Egypt. J. Neurosurg. 34, (2019).