title: The Nelaton Catheter Guard for Safe and Effective Placement of Subdural Drain for Two-Burr-Hole Trephination in Chronic Subdural Hematoma: A Technical Note.
abstract: BACKGROUND
  For chronic subdural hematoma, placement of a Blake drain with a two-burr-hole craniotomy is often preferred. However, the placement of such drains carries the risk of penetrating the brain surface or damaging superficial venous structures.
  
  
  OBJECTIVE
  To describe the use of a Nelaton catheter for the placement of a subdural drain in two-burr-hole trephination for chronic subdural hematoma.
  
  
  METHODS
  A Nelaton catheter was used to guide placement of a Blake drain into the subdural hematoma cavity and provide irrigation of the hematoma cavity. With the two-burr-hole method, the Nelaton catheter could be removed easily via the frontal burr hole after the Blake drain was in place.
  
  
  RESULTS
  We used the Nelaton catheters in many surgical procedures and found it a safe and easy technique. This method allows the surgeon to safely direct the catheter into the correct position in the subdural space.
  
  
  CONCLUSIONS
  This tool has two advantages. First, the use of a small and flexible Nelaton catheter is a safe method for irrigation of a chronic subdural hematoma cavity. Second, in comparison with insertion of subdural drainage alone through a burr hole, the placement of the Nelaton catheter in subdural space is easier and the risk of damaging relevant structures such as cortical tissue or bridging veins is lower. Thus this technique may help to avoid complications when placing a subdural drain.
authors.affiliation: Department of Neurosurgery, Inselspital Bern University of Bern, Bern, Switzerland.
authors.forename: Jens
authors.initials: J
authors.lastname: Fichtner
authors.affiliation: Department of Neurosurgery, Inselspital Bern University of Bern, Bern, Switzerland.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Beck
authors.affiliation: Department of Neurosurgery, Inselspital Bern University of Bern, Bern, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Raabe
authors.affiliation: Department of Neurosurgery, Zurich University Hospital, Zurich, Switzerland.
authors.forename: Lennart Henning
authors.initials: LH
authors.lastname: Stieglitz
mesh_terms: D002404:Catheterization / Q000295:instrumentation / Q000379:methods / Q000592:standards; D057785:Catheters; D004322:Drainage / Q000295:instrumentation / Q000379:methods / Q000592:standards; D020200:Hematoma, Subdural, Chronic / Q000601:surgery*; D006801:Humans; D013355:Subdural Space / Q000601:surgery; D014207:Trephining / Q000379:methods* / Q000592:standards