The Effectiveness and Safety of Burr Hole Evacuation in Chronic Subdural Hematoma Patients – Experience from a Low-Income Country


  • Faiqa Filza Neurosurgery
  • Almas Fasih Khattak
  • Leena Ayesha
  • Khial Jalal
  • Wajid Ali
  • Majid Ayaz
  • Zahid Khan



Background: In contemporary neurosurgery, burr holes are fundamental in cranial procedures, primarily for the evacuation of chronic subdural hematomas (CSDH). CSDH is prevalent, and its clinical course, though not life-threatening, carries morbidity and mortality risks. This study evaluates the effectiveness and safety of Burr Hole Evacuation (BHE) for CSDH, aiming to assess clinical outcomes, immediate postoperative complications, and patient satisfaction.

Methodology: This retrospective cohort study analyzed data from patients who underwent BHE for CSDH between March 2015 and August 2023. Inclusion criteria encompassed well-documented CSDH diagnoses, comprehensive medical records, and primary BHE cases, excluding previous neurosurgical interventions and pediatric cases. Data included patient demographics, clinical presentation, imaging findings, surgical details, post-operative outcomes, and patient satisfaction. Analysis was performed using SPSS version 25.

Results: The study included 86 patients, predominantly male (85%) with a mean age of 54 years. Clinical presentations varied, with headaches (85%) being the most common symptom. CT scans were pivotal for diagnosis, revealing hypodensities primarily over the convexity. BHE was performed without complications, resulting in favorable post-operative outcomes (93% significant recovery, 7% extended hospital stays). No intraoperative or post-operative mortality occurred, and there were no recurrent hematomas. Patient satisfaction with BHE was high (97%).

Conclusion: BHE is a viable primary surgical intervention for CSDH in low-income settings, with positive outcomes, safety, and patient satisfaction. Further studies and collaborative efforts are essential to enhance neurosurgical treatment in these settings and explore long-term outcomes.


Uno M, Toi H, Hirai S. Chronic Subdural Hematoma in Elderly Patients: Is this Disease Benign? Neurol Med Chir. 2017;57:402–9.

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. 2019;10(1):113–8.

Ahmed OEF, El Sawy A, El Molla S. Surgical management of chronic subdural hematomas through single-burr hole craniostomy: is it sufficient? Egypt J Neurol Psychiatry Neurosurg [Internet]. 2021;57(1). Available from:

Gelabert-González M, Iglesias-Pais M, García-Allut A, Martínez-Rumbo R. Chronic subdural haematoma: Surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg. 2005;107(3):223–9.

Miranda LB, Braxton E, Hobbs J, Quigley MR. Chronic subdural hematoma in the elderly: Not a benign disease. Clinical article. J Neurosurg. 2011;114(1):72–6.

Lee K-S. History of Chronic Subdural Hematoma. Korean J Neurotrauma. 2015;11(2):27.

Santarius T, Lawton R, Kirkpatrick PJ, Hutchinson PJ. The management of primary chronic subdural haematoma: A questionnaire survey of practice in the United Kingdom and the Republic of Ireland. Br J Neurosurg. 2008;22(4):529–34.

Yadav, Yad R, Parihar V. Chronic subdural hematoma. Asian J Neurosurg [Internet]. 2016;11(4):330–42. Available from:

Berghauser Pont LME, Dirven CMF, Dippel DWJ, Verweij BH, Dammers R. The role of corticosteroids in the management of chronic subdural hematoma: A systematic review. Eur J Neurol. 2012;19(11):1397–403.

Stavrinou P, Katsigiannis S, Lee JH, Hamisch C, Krischek B, Mpotsaris A, et al. Risk Factors for Chronic Subdural Hematoma Recurrence Identified Using Quantitative Computed Tomography Analysis of Hematoma Volume and Density. World Neurosurg. 2017;99:465.

Alcalá-Cerra G, Young AMH, Moscote-Salazar LR, Paternina-Caicedo Á. Efficacy and safety of subdural drains after burr-hole evacuation of chronic subdural hematomas: Systematic review and meta-analysis of randomized controlled trials. World Neurosurg. 2014;82(6):1148–57.

Hode L, et al. Treatment and Outcome of Chronic Subdural Hematoma in Sub-Saharan Afrcia and the Country of Benin. Iran J Neurosurg. 2015;1(2):31–5.

De Bonis P, Olei S, Mongardi L, et al. Chronic subdural hematoma in patients aged 80 years and older: a two-centre study. Clin Neurol Neurosurg. 2018;170:88–92. [PubMed: 29772363]

Yadav Y, Parihar V, Namdev H, Bajaj J. Chronic subdural hematoma. Asian J Neurosurg. 2016 Dec;11(4):330-42. [PubMed: 28163407]

Edlmann E, Giorgi-Coll S, Whitfield PC, Carpenter KL, Hutchinson PJ. Pathophysiology of chronic subdural hematoma: inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation. 2017 Dec;14(1):1-3. [PubMed: 29298683]

Holl DC, Volovici V, Dirven CM, Peul WC, van Kooten F, Jellema K, van der Gaag NA, Miah IP, Kho KH, den Hertog HM, Lingsma HF. Pathophysiology and nonsurgical treatment of chronic subdural hematoma: from past to present to future. World Neurosurg. 2018 Aug 1;116:402-11. [PubMed: 29885517]

Feghali J, Yang W, Huang J. Updates in chronic subdural hematoma: epidemiology, etiology, pathogenesis, treatment, and outcome. World Neurosurg. 2020 Sep 1;141:339-45. [PubMed: 32438124]

Mekaj AY, Morina AA, Mekaj YH, Manxhuka-Kerliu S, Miftari EI, Duci SB, Hamza AR, Gashi MM, Xhelaj MR, Kelmendi FM, Morina QS. Surgical treatment of 137 cases with chronic subdural hematoma at the university clinical center of Kosovo during the period 2008-2012. J Neurosci Rural Pract. 2015 Feb;6(2):186-90. [PubMed: 25883455]

Soleman J, Nocera F, Mariani L. The conservative and pharmacological management of chronic subdural hematoma: a systematic review. Swiss Med Wkly. 2017 Jan 17;147:w14398. [PubMed: 28101845]

Kageyama H, Toyooka T, Tsuzuki N, Oka K. Nonsurgical treatment of chronic subdural hematoma with tranexamic acid. J Neurosurg. 2013;119(2):332–7. [PubMed: 23706092]

Blaauw J, Meelis GA, Jacobs B, van Der Gaag NA, Jellema K, Kho KH, Groen RJ, van Der Naalt J, Lingsma HF, den Hertog HM. Presenting symptoms and functional outcome of chronic subdural hematoma patients. Acta Neurol Scand. 2022 Jan;145(1):38-46. [PubMed: 34342225]

Brennan PM, Kolias AG, Joannides AJ, Shapey J, Marcus HJ, Gregson BA, Grover PJ, Hutchinson PJ, Coulter IC. The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom. J Neurosurg. 2016 Nov 11;127(4):732-9. [PubMed: 27834615]

Abe Y, Maruyama K, Yokoya S, Noguchi A, Sato E, Nagane M, Shiokawa Y. Outcomes of chronic subdural hematoma with preexisting comorbidities causing disturbed consciousness. J Neurosurg. 2017 Apr 1;126(4):1042-6. [PubMed: 27035532]






Original Articles