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You’re scrubbing into
Burr-hole drainage of chronic subdural
Why are we operating?
Two small holes in the skull to let out the old blood that has been slowly squeezing an older brain; among neurosurgery's simplest operations and most grateful recoveries.
Indication: Symptomatic chronic subdural haematoma, typically weeks after minor trauma in an older or anticoagulated patient.
Read the imaging first
Practice before you scrub
Name the compartment
Knocked out briefly at football, talking normally in the ED, now drowsy two hours later. CT head. (Fictional educational case.)
- Lens means extradural, and extradural means arterial: a middle meningeal bleed under a pterional impact, on a clock measured in hours.
- Shift and effacement grade the urgency better than the collection's size alone: mass effect is the pressure story made visible.
The operation in 4 steps
01Planning from the scan
Burr-hole sites are marked over the thickest collection, usually two spaced along it, away from dural venous sinuses.
02The burr holes
Scalp incisions, then the perforator makes each hole; bone wax and diathermy manage bone and scalp bleeding.
03Opening the dura and washing out
The dura is coagulated and opened crosswise; machine-oil fluid drains, and warm saline is irrigated between holes until clear.
04Subdural drain and closure
A soft drain is left in the subdural space a day or two, the scalp closed in layers, and the patient nursed to encourage brain re-expansion.
Anatomy you need
The brain surface the subdural collection compresses; the burr hole is planned over the thickest part of it.
What can go wrong
Watch it done
Chronic subdural hematoma management
Who gets burr holes, who gets watched, and what recurrence means.
Source: Johns Hopkins Medicine · Watch on YouTube
Conceptual teaching for learners preparing to observe and assist under supervision, not operative instructions. Five minutes from now you should know why this operation exists, what its shape is, and which structures it is designed not to injure.