Surgical Outcome of Subdural Hematoma by Single Vs Double Burr Hole Technique

  • ASAD JAVED Quaid e Azam International hospital, Rawalpindi
  • SULTAN JALAL-UD-DIN FAISAL Liaqat National Hospital, Karachi
  • NIAZ AHMED PIMS, Islamabad
  • SULTAN SHAH Ponch Medical College, AJK
  • MUHAMMAD SAJID MEHMOOD Frontier Medical College, Abbottabad
  • SAJID RAZZAQ Assistant Professor Surgery, Poonch Medical College, Rawalakot, AJK
  • SHAMSUD DIN Quaid-e-Azam International Hospital, Rawalpindi,
Keywords: Chronic Subdural Hematoma, Single burr-hole craniotomy, Double burr-hole craniotomy


Objective: To determine frequency of a favorable outcome of chronic subdural hematoma patients by single vs. double burr hole technique.
Materials and Methods: A randomized controlled trial was done in Neurosurgery Department, Pakistan Institute of Medical Sciences, Islamabad from 15th September 2016 to 15th August 2017. All patients in group A were operated through a single burr-hole technique either under general anesthesia or local. Group B patients were operated through double burr-hole technique.
Results: One hundred patients were included in this study, divided into two groups. Group A had mean age 54 years with STD of ± 5.7 while in group B, mean age was 53 years with STD of ± 6.3. In group A there were 35 (70%) male and 15 (30%) female patients while group B had 30 (60%) male and 20 (40%) female patients. In group A, mean GCS was 12.78 with STD of ± 1.4. In group B, mean GCS was 12.64 with STD of ± 1.3. The favorable outcome after surgery was attained in 43 (86%) patients in Group A while 46 (92%) patients in Group B.
Conclusion: Chronic subdural hematoma is a complication seen in older age after trivial trauma history. Single burr-hole drainage of hematoma is an effective method of treatment when compared with double burr-hole method which is more time consuming.


1. Nayil K. et al. Chronic Subdural Hematomas: Single or Double Burr Hole. Turk Neurosurg. 2014; 24 (2): 246-8.
2. Andersen N C,Poulsen F R, Bergholt B, Hundsholt T, Fugleholm K. Bilatral chronic subdural hematoma: unilateral or bilateral derainage?.J Neurosurg. 2017; 126: 1905-1911.
3. Liu W, Bakker N A, Groen R J M. Chronic Subdural Heamtoma: A Systemic Review and Meta-Analysis of Surgical Procedures. J Neurosurg. 2014; 121: 665-673.
4. Miranda L B, Braxton E, Hobbs J, Quigley M R. Chronic Subdural Hematoma In Elderly: Not A BenignDisease. J Neurosurg. 2011; 114: 72-76.
5. Leroy H-A, Aboukais R, Reyns N, Bourgeois P, Labreuche J, Duhamel A et al. Predictors Of Functional Outcomes And Recurrence Of Chronic Subdural Hematomas. J Clin Neurosci. 2015; 22 (12): 1895-900.
6. Javadi A, Amirjamshidi A, Aran S, Hosseini SH, A Randomized Controlled Trial Comparing The Outcome of Burr-Hole Irrigation With and Without Drainage in The Treatment of Chronic Subdural Hematoma: A Preliminary Report. World Neurosurg. 2011; 75 (5-6): 731-6.
7. Henaux P-L, Le Reste P-J, Laviolle B, Morandi X. Steroids In Chronic Subdural Hematomas (SUCRE Trial): Study Protocol For A Randomized Controlled Trial. Trials. 2017; 18: 252.
8. Belkhair S, Pickett G. One Versus Double Burr Holes For Treating Chronic Subdural Hematoma Meta-Analysis. Can J Neurol Sci. 2013; 40: 56-60.
9. Chari A, Kolias A, Santarius T, Bond Simon, Hutchinson P J. Twist – Drill Craniostomy with Hollow Screws for Evacuation of Chronic Subdural Hematoma. J Neurosurg. 2014; 121: 176-183.
10. Balser D, Rodgers SD, Johnson B, Shi C, Tabak E, Samadami U, Evolving Management Of Symptomatic Chronic Subdural Hematoma: Experience Of A Single Institution And Review Of The Literature. Neurol Res. 2013; 35 (3): 233-42.
11. Pahatouridis D, Alexiou GA, Fotakopoulos G, Mihos E, Zigouris A, Drosos D, et al. Chronic Subdural Haematomas: A Comparative Study Of An Enlarged Single Burr Hole Versus Double Burr Hole Drainage. Neurosurgical Review, 2013; 36: 151-5.
12. Baechli H, Nordmann A, Bucher HC, Gratzl O. Demographics and Prevalent Risk Factors of Chronic Subdural Haematoma: Results of a Large Single-Center Cohort Study. Neurosurgical Review, 2004; 27: 263-6.
13. A. Single Versus Double Burr Hole Drainage of Chronic Subdural Hematomas. A Study of 267 Cases. J Clin Neuroscience, 2010; 17: 428-9.
14. Edward B, Bridges, McIntyre BR, Madden TA, William O. The Single Burr Hole Technique for the Evacuation of Non-Acute Subdural Hematomas. J Trauma-Injury Infec Crit Care, 1994; 36: 96-102.
15. Pang CU et al. Acute Intracrainl Bleeding and Recurrence After Burhole Craniostomy for Chronic Subdural Hematoma. J Neuro Surg. 2015; 7: 65-74.
16. Smith MD et al. Surgical Management of Chronic Subdural Hematoma: One Hole or Two? International Journal of Surgery, 2012; 10: 450-452.
17. Ur Rehman R, Khattak A, AzamF, Alam W. Outcome Of Chronic Subdural Hematoma Patients Treated By Two Burr Holes Method. Gomal J Med Sci. 1010; 8 (2): 76-84.
18. Khanzada K, Ali M. Management of Chronic Subdural Hematoma. J Postgrad Med Inst. 2011; 18: 37-43.
Original Article