BurrHoleDrainage

Burr hole drainage is a neurosurgical procedure that involves creating a small hole, or burr hole, in the skull to access the intracranial space for evacuation and drainage of collected fluids or pus. The technique is used to relieve pressure and remove pathological accumulations such as hematomas or abscesses through a less invasive approach than a full craniotomy.

Indications for burr hole drainage include evacuation of certain intracranial hematomas, particularly chronic subdural hematomas, where medical comorbidity or age makes extensive surgery riskier or where rapid decompression is needed. It is also employed for selected acute subdural or epidural hematomas, subdural empyema, and cranial abscesses or localized collections that can be accessed through a burr hole. In some cases, burr holes are used to drain subdural hygromas or to place external drainage systems to monitor and control cerebrospinal fluid.

The procedure typically involves drilling one or more burr holes over the area of pathology under general anesthesia or, in carefully selected cases, local anesthesia with sedation. The dura is opened, the collection is evacuated, and residual membranes may be fenestrated. A drain may be left in place to allow continued drainage. Image guidance or neuronavigation can aid positioning, and postoperative imaging is used to assess clearance and positioning.

Outcomes and risks vary with the underlying condition and patient factors. Burr hole drainage can provide rapid relief of mass effect with shorter operative times and hospitalization compared with larger craniotomies. Potential complications include infection, recurrent or residual collection, rebleeding, brain injury, seizures, and wound problems. Recurrence is particularly noted in chronic subdural hematomas, which may require additional treatment.