Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2018 Nov;160(11):2129-2135.
doi: 10.1007/s00701-018-3659-9. Epub 2018 Aug 28.

Improving the aesthetic outcome with burr hole cover placement in chronic subdural hematoma evacuation-a retrospective pilot study

Flavio Vasella  1 , Kevin Akeret  1 , Nicolas R Smoll  2 , Menno R Germans  1 , Elisabeth Jehli  1 , Oliver Bozinov  1 , Luca Regli  1 , Martin N Stienen  3   4 ; CORRECT SCAR study group
Collaborators, Affiliations
Randomized Controlled Trial

Improving the aesthetic outcome with burr hole cover placement in chronic subdural hematoma evacuation-a retrospective pilot study

Flavio Vasella et al. Acta Neurochir (Wien). 2018 Nov.

Abstract

Background: The aesthetic outcome after burr hole trepanation for the evacuation of chronic subdural hematomas (cSDH) is often unsatisfactory, as the bony skull defects may cause visible skin depressions. The purpose of this study was to evaluate the efficacy of burr hole cover placement to improve the aesthetic outcome.

Methods: We reviewed consecutive patients treated by burr hole trepanation for cSDH with or without placement of burr hole covers by a single surgeon between October 2016 and May 2018. The clinical data, including complications, were derived from the institution's prospective patient registry. The primary endpoint was the aesthetic outcome, as perceived by patients on the aesthetic numeric analog (ANA) scale, assessed by means of a standardized telephone interview. Secondary endpoints were skin depression rates and wound pain, as well as complications.

Results: From n = 33, outcome evaluation was possible in n = 28 patients (n = 24 male; mean age of 70.4 ± 16.1 years) with uni- (n = 20) or bilateral cSDH (n = 8). A total of 14 burr hole covers were placed in 11 patients and compared to 50 burr holes that were not covered. Patient satisfaction with the aesthetic outcome was significantly better for covered burr holes (mean ANA 9.3 ± 0.74 vs. 7.9 ± 1.0; p < 0.001). Skin depressions occurred over 7% (n = 1/14) of covered and over 92% (n = 46/50) of uncovered burr holes (p < 0.001). There was no difference in wound pain (p = 0.903) between covered and uncovered sites. No surgical site infection, cSDH recurrence, or material failure was encountered in patients who had received a burr hole plate.

Conclusions: In this retrospective series, placement of burr hole covers was associated with improved aesthetic outcome, likely due to reduction of skin depressions. A randomized controlled trial is developed to investigate whether adding burr hole covers results in superior aesthetic outcomes, without increasing the risk for complications.

Keywords: Aesthetic outcome; Burr hole cover; Burr hole plate; Chronic subdural hematoma; Complications; Patient satisfaction; Scar; Trepanation.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest

All the authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

The local ethics committee (Kantonale Ethikkommission KEK-ZH 2012–0244) approved the prospective collection and analysis of data in the patient registry. The study was registered at http://clinicaltrials.gov (NCT01628406) and follows the STROBE recommendation for observational studies. All patients consented to the additional telephone interview. No funding was received for this study. Informed consent was obtained from all individual participants for whom identifying information is included in this article.

Figures

Fig. 1
Fig. 1
Illustrative picture of a 76-year-old male patient, seen in outpatient clinics about 12 weeks after right-sided frontal and parietal burr hole trepanation for a cSDH, with the trepanation site not covered by a burr hole plate
Fig. 2
Fig. 2
Study algorithm demonstrating how the intervention and control groups were arrived at
Fig. 3
Fig. 3
Box plot (25th to 75th percentile and mean) with whiskers (5th–95th percentile) and outliers (points). The mean aesthetic satisfaction (ANA) score in the intervention group was 9.3 (SD 0.74) and 7.9 in the control group (SD 1.0, ***p < 0.001)
Fig. 4
Fig. 4
The rate of skin depressions over covered burr holes was 7% (1/14) and 92% (46/50) over burr holes that are not covered (***p < 0.001)
Fig. 5
Fig. 5
Illustrative picture of an 91-year-old male patient, seen in outpatient clinics about 16 weeks after right-sided frontal and parietal burr hole trepanation for a cSDH, with the trepanation site covered by a burr hole plate
See this image and copyright information in PMC

References

    1. Baschera Dominik, Tosic Lazar, Westermann Leonard, Oberle Joachim, Alfieri Alex. Treatment Standards for Chronic Subdural Hematoma: Results from a Survey in Austrian, German, and Swiss Neurosurgical Units. World Neurosurgery. 2018;116:e983–e995. doi: 10.1016/j.wneu.2018.05.145. - DOI - PubMed
    1. Bellut D, Woernle CM, Burkhardt JK, Kockro RA, Bertalanffy H, Krayenbühl N. Subdural drainage versus subperiosteal drainage in burr-hole trepanation for symptomatic chronic subdural hematomas. World Neurosurg. 2012;77:111–118. doi: 10.1016/j.wneu.2011.05.036. - DOI - PubMed
    1. Ducruet AF, Grobelny BT, Zacharia BE, Hickman ZL, DeRosa PL, Anderson K, Sussman E, Carpenter A, Connolly ES. The surgical management of chronic subdural hematoma. Neurosurg Rev. 2012;35(2):155–169. doi: 10.1007/s10143-011-0349-y. - DOI - PubMed
    1. Funk W, Podmelle F, Guiol C, Metelmann HR. Aesthetic satisfaction scoring - introducing an aesthetic numeric analogue scale (ANA-scale) J Cranio-Maxillofacial Surg. 2012;40:439–442. doi: 10.1016/j.jcms.2011.07.018. - DOI - PubMed
    1. Gelabert-González Miguel, Iglesias-Pais Miguel, García-Allut Alfredo, Martínez-Rumbo Ramón. Chronic subdural haematoma: surgical treatment and outcome in 1000 cases. Clinical Neurology and Neurosurgery. 2005;107(3):223–229. doi: 10.1016/j.clineuro.2004.09.015. - DOI - PubMed

Publication types