Complications of burr-hole craniostomy and closed-system drainage for chronic subdural hematomas: a retrospective analysis of 376 patients.
OBJECTIVE
Burr-hole craniostomy with closed-system drainage (BCD) is the most frequently used neurosurgical treatment of chronic subdural hematomas (cSDH). The surgical and medical complications of BCD have seldom been investigated systematically. The objective of this study was to define the frequency of surgical and medical complications following BCD for cSDH.


METHODS
The medical records of 376 patients managed by BCD were reviewed with respect to complications during the hospital stay.


RESULTS
Seventy-seven surgical complications (20.5%) were encountered. The most frequent minor complication after surgery was seizures (n 51, 13.6%). The most frequent major surgical complications were intracerebral hemorrhage and subdural empyema (n 8, 2.1% each). Four patients with intracerebral hemorrhage died, accounting for a surgical mortality rate of 1.1%. Fifty-nine medical complications (15.7%) occurred during the hospital stay. Pneumonia was the most frequent medical complication (n 29, 7.7%). Medical complications were fatal in 24 patients, accounting for a mortality rate of 6.4%. In 22 patients (5.8%), death was not related to a complication, but to the initial brain damage. The overall mortality rate was 13.3%.


CONCLUSIONS
The rate of complications in patients with cSDH who underwent the BCD is high. The clinical relevance of medical complications has to be emphasized because of their substantial contribution to overall mortality.
Rohde
Veit
V
Department of Neurosurgery, Klinikum Kalkweg, Duisburg, Germany. vrohde@post.klinikum.rwth-aachen.de
Graf
G
G
Hassler
W
W
D002908:Chronic Disease; D003399:Craniotomy / Q000009:adverse effects* / Q000379:methods*; D004322:Drainage / Q000009:adverse effects*; D006408:Hematoma, Subdural / Q000401:mortality / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome