Evaluating the optimal number of burr-holes for treating chronic subdural haematomas: good results from a single burr-hole?

INTRODUCTION: Chronic subdural haematomas (cSDH) are one of the most common types of traumatic intracranial lesion. Burr-hole craniostomy followed by closed-system drainage has become the treatment of choice. However, there is no definitive indication as to the number of burr-holes needed. Our aim was to to assess clinical and radiological outcomes taking into account the number of burr-holes made. MATERIAL AND METHODS: A retrospective single-centre-study was performed including patients treated for cSDH by performing burr-hole craniostomy from 2012 to 2018. After collecting data regarding demographics, comorbidities, and clinical and radiological records, haematomas were grouped depending on the number of burr-holes made (Group 1: single burr-hole; Group 2: double burr-holes). Clinical and radiological outcomes were statistically compared between groups, as well as the main complications. RESULTS: After collecting 171 patients, 205 cSDHs were analysed. 173 were treated with a single burr-hole (we called these Group 1) and 32 with double burr-holes (Group 2). No differences in preoperative characteristics were found between the groups, except for diabetes mellitus and previous antiplatelet/anticoagulation treatment. No radiological differences were found regarding haematoma volume (p = 0.7) or thickness (p = 0.3). Surgical site infection (p = 0.13), recurrence (p = 0.6), acute rebleeding (p = 0.25) and mortality (p = 0.94) were assessed without evidencing statistically significant differences. At the time of hospital discharge, most patients showed a remarkable clinical improvement, regardless of the number of burr-holes made (p = 0.7). CONCLUSIONS: This study suggests that cSDH can be efficiently evacuated by a single burr-hole craniostomy, a less invasive and shorter surgical procedure with quite good clinical outcomes and a low rate of complications.

Compresión medular secundaria a quiste aracnoideo intradural de etiología traumática / Spinal cord compression secondary to traumatic intradural arachnoid cyst

Los quistes aracnoideos espinales son entidades raras y casi siempre tienen una etiología congénita o espontánea. Los casos secundarios son muy poco frecuentes y muchas veces constituyen una causa de deterioro neurológico tras varios meses o años de un traumatismo espinal. Presentamos el caso de un varón diagnosticado de quiste aracnoideo espinal de etiología traumática, agrupamos los casos descritos hasta el momento en la literatura y revisamos las distintas opciones quirúrgicas relacionándolas con las teorías fisiopatológicas que tratan de explicar la génesis de estas lesiones

Spinal arachnoid cysts are rare entities, most of which have a congenital or spontaneous etiology. Secondary cases are infrequent and can constitute a cause of neurological deterioration several months or years after spinal trauma. We present the case of a male patient with traumatic spinal arachnoid cyst, together with a review of the cases published to date. Finally, we explain the different surgical options for this pathology relating them to the physiopathological theories that try to explain the origin of these lesions

Spinal cord compression secondary to traumatic intradural arachnoid cyst. / Compresión medular secundaria a quiste aracnoideo intradural de etiología traumática.

Spinal arachnoid cysts are rare entities, most of which have a congenital or spontaneous etiology. Secondary cases are infrequent and can constitute a cause of neurological deterioration several months or years after spinal trauma. We present the case of a male patient with traumatic spinal arachnoid cyst, together with a review of the cases published to date. Finally, we explain the different surgical options for this pathology relating them to the physiopathological theories that try to explain the origin of these lesions.