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

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...

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Autores principales: Vasella, Flavio, Akeret, Kevin, Smoll, Nicolas R., Germans, Menno R., Jehli, Elisabeth, Bozinov, Oliver, Regli, Luca, Stienen, Martin N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Vienna 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6209004/
https://www.ncbi.nlm.nih.gov/pubmed/30155645
http://dx.doi.org/10.1007/s00701-018-3659-9
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author Vasella, Flavio
Akeret, Kevin
Smoll, Nicolas R.
Germans, Menno R.
Jehli, Elisabeth
Bozinov, Oliver
Regli, Luca
Stienen, Martin N.
author_facet Vasella, Flavio
Akeret, Kevin
Smoll, Nicolas R.
Germans, Menno R.
Jehli, Elisabeth
Bozinov, Oliver
Regli, Luca
Stienen, Martin N.
author_sort Vasella, Flavio
collection PubMed
description 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.
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spelling pubmed-62090042018-11-13 Improving the aesthetic outcome with burr hole cover placement in chronic subdural hematoma evacuation—a retrospective pilot study Vasella, Flavio Akeret, Kevin Smoll, Nicolas R. Germans, Menno R. Jehli, Elisabeth Bozinov, Oliver Regli, Luca Stienen, Martin N. Acta Neurochir (Wien) Original Article - Neurosurgical technique evaluation 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. Springer Vienna 2018-08-28 2018 /pmc/articles/PMC6209004/ /pubmed/30155645 http://dx.doi.org/10.1007/s00701-018-3659-9 Text en © The Author(s) 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article - Neurosurgical technique evaluation
Vasella, Flavio
Akeret, Kevin
Smoll, Nicolas R.
Germans, Menno R.
Jehli, Elisabeth
Bozinov, Oliver
Regli, Luca
Stienen, Martin N.
Improving the aesthetic outcome with burr hole cover placement in chronic subdural hematoma evacuation—a retrospective pilot study
title Improving the aesthetic outcome with burr hole cover placement in chronic subdural hematoma evacuation—a retrospective pilot study
title_full Improving the aesthetic outcome with burr hole cover placement in chronic subdural hematoma evacuation—a retrospective pilot study
title_fullStr Improving the aesthetic outcome with burr hole cover placement in chronic subdural hematoma evacuation—a retrospective pilot study
title_full_unstemmed Improving the aesthetic outcome with burr hole cover placement in chronic subdural hematoma evacuation—a retrospective pilot study
title_short Improving the aesthetic outcome with burr hole cover placement in chronic subdural hematoma evacuation—a retrospective pilot study
title_sort improving the aesthetic outcome with burr hole cover placement in chronic subdural hematoma evacuation—a retrospective pilot study
topic Original Article - Neurosurgical technique evaluation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6209004/
https://www.ncbi.nlm.nih.gov/pubmed/30155645
http://dx.doi.org/10.1007/s00701-018-3659-9
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