Anjum Q, Raza Rizvi, Hemna Siddiqui.
Burr hole Craniostomy for chronic subdural hematoma.
J Coll Physicians Surg Pak Jan ;15(11):746.

The aim of this study was to evaluate the role of burr hole craniostomy for the surgical management of patients with CSH. A case review of patients admitted in the Neurosurgery Department was performed. The data was collected on a proforma including age, gender, glasgow coma score (GCS) and CT scan findings on admission, management and outcome of the patient. The variables were categorized into two or three classes. Age was grouped into less than and more than 60 years. Co-morbidity like diabetes mellitus and hypertension were recorded as present or absent. GCS was categorized into class I (score 12- 15), class II (score 8-11) and class III ( score 3-7). Location of CSH on CT scan was observed as either on the right or left side of the brain. The surgical management was either burr hole craniostomy or craniotomy. Outcome was also dichotomous, either alive or expired. A total of 90 cases were admitted with the diagnosis of CSH during the mentioned period. The main clinical presentations were headaches followed by altered mental status, progressive focal neurological deficit and a few cases presenting as a transient neurological deficit. The mean age at presentation was 67 ± 9 years, with male to female ratio of 3:2 as shown in Table I. Only 9% patients had any associated co-morbidity. The location of CSH on CT scan findings was right side of the brain in 51 (57%) and left side of the brain in 39 (43%) patients. GCS on admission was class I in 41%, class II in 46% and class III in 13% of the enrolled subjects. A large number (93%) were managed by burr hole craniostomy and the outcome was favorable in 94% patients. The mortality in craniostomy patients was 66.67% whereas only 1.2% mortality was observed in burr hole craniostomy. No major reportable postoperative complication was observed. The average duration of stay in the hospital after burr hole craniostomy was 4 days.

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