Tag: Burr-hole drainage

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A comparative study of robot‑assisted and manual pore cranial drilling and drainage for spontaneous supratentorial intracerebral hemorrhage

Neurosurgical Review (2025) 48:438

The study compares robot-assisted versus manual pore cranial drilling and drainage for spontaneous supratentorial intracerebral hemorrhage. Robot assistance showed superior outcomes in hematoma clearance, operative efficiency, and complication rates, suggesting potential advantages over manual methods, though further trials are needed for confirmation.

• Study Objective: The research compares the effectiveness of robot-assisted versus manual pore cranial drilling and drainage for treating spontaneous supratentorial intracerebral hemorrhage (SSICH).

• Key Findings: Robot-assisted techniques showed superior results in hematoma clearance, operative efficiency, and complication rates compared to manual methods.

• Technological Advantage: The use of the Remebot version 4.1.0.3 robot demonstrated enhanced precision and efficiency, leading to better surgical outcomes.

• Statistical Analysis: The study used statistical tests like ANCOVA to adjust for confounders, showing significant differences favoring robot-assisted methods in key surgical outcomes.

• Results: Robot-assisted surgeries resulted in lower postoperative hematoma volumes, higher clearance rates, shorter surgical durations, and fewer complications.

• Subgroup Analysis: Notable improvements were observed in cases with a rightward mid-line shift, highlighting the benefits of robotic assistance in complex cases.

• Future Recommendations: Further prospective, multicenter, randomized controlled trials are needed to confirm the broader applicability and cost-effectiveness of robotic techniques in neurosurgery.

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Reducing morbidity associated with subdural drain placement after burr‑hole drainage of unilateral chronic subdural hematomas

Acta Neurochirurgica (2023) 165:3207–3215

Placement of a subdural drain after burr-hole drainage of chronic subdural hematoma (cSDH) significantly reduces risk of its recurrence and lowers mortality at 6 months. Nonetheless, measures to reduce morbidity related to drain placement are rarely addressed in the literature. Toward reducing drain-related morbidity, we compare outcomes achieved by conventional insertion and our proposed modification.

Methods In this retrospective series from two institutions, 362 patients underwent burr-hole drainage of unilateral cSDH with subsequent subdural drain insertion by conventional technique or modified Nelaton catheter (NC) technique. Primary endpoints were iatrogenic brain contusion or new neurological deficit. Secondary endpoints were drain misplacement, indication for computed tomography (CT) scan, re-operation for hematoma recurrence, and favorable Glasgow Outcome Scale (GOS) score (≥ 4) at final follow-up.

Results The 362 patients (63.8% male) in our final analysis included drains inserted in 56 patients by NC and 306 patients by conventional technique. Brain contusions or new neurological deficits occurred significantly less often in the NC (1.8%) than conventional group (10.5%) (P = .041). Compared with the conventional group, the NC group had no drain misplacement (3.6% versus 0%; P = .23) and significantly fewer non-routine CT imaging related to symptoms (36.5% versus 5.4%; P < .001). Re-operation rates and favorable GOS scores were comparable between groups.

Conclusion We propose the NC technique as an easy-to-use measure for accurate drain positioning within the subdural space that may yield meaningful benefits for patients undergoing treatment for cSDH and vulnerable to complication risks.

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Preoperative predictive factors for surgical and functional outcomes in chronic subdural hematoma

Subdural Hematoma

Acta Neurochir (2016) 158:135–139

Chronic subdural hematoma (CSDH) is a frequently encountered neurosurgical condition, especially in the elderly. We investigated predictive factors for surgical and functional outcomes after burr-hole drainage (BHD) surgery.

Methods All patients with CSDH treated by BHD between January 2012 and December 2014 were included in this study. All patients were classified by symptom, clinical grade, time, location, hematoma density, midline shift, and other characteristics. Pre- and postoperative CT evaluation was performed at 0, 3, and 6 months. Clinical grades were classified as described in Markwalder et al. Surgical and clinical outcomes were evaluated with the brain expansion rate and modified Rankin Scale (mRS). Brain expansion rate was calculated as the ratio between post- and pre-operative hematoma thickness. Recurrence was defined as the occurrence of symptoms and hematoma on CT within 6 months.

Results This study included 130 patients over 2 years. Among the variable parameters, young age (<75), iso-density of hematoma on CT, and short duration from symptom to surgery were correlated with good brain expansion. Patients with good brain expansion had fewer recurrences. In terms of mRS, young age, iso-density, and good clinical grade were correlated with good functional outcomes.

Conclusions Clinicians should be more aware of general conditions and medical problems, especially in elderly patients. Membranectomy should be considered in patients with a long duration of symptoms or hypo-dense hematomas to promote good brain expansion and good mRS scores.

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