Successful Burr Hole Evacuation for Left Frontoparietal Chronic Subdural Hematoma

Chief Complaints

A 70-year-old male patient with a body mass index (BMI) of 20 presented to the Neurosurgery Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of forgetfulness and slowness of walking for 10 days. He also had a history of multiple falls and restriction in daily activities during the same period. There were no complaints of headache, vomiting, seizures, loss of consciousness, or blurring of vision.

The patient was not a known case of diabetes mellitus or hypertension. He had a history of percutaneous transluminal coronary angioplasty (PTCA) with stenting in the past and was on dual antiplatelet therapy, which was stopped before surgery as advised. No other significant medical history was mentioned.

Upon examination, the patient was moderately built and nourished, with stable vital signs. Cardiovascular, respiratory, and abdominal examinations were within normal limits. Neurological examination showed mild weakness on the right side, with power of 4/5 in the right upper and lower limbs, while the left upper and lower limbs had normal power of 5/5. Other central nervous system findings were normal.

Upon admission to PACE Hospitals, the patient underwent a comprehensive clinical evaluation along with a detailed review of his medical history and preoperative investigations conducted by the Neurosurgery team.

The patient presented with forgetfulness, slowness of walking, multiple falls, and difficulty performing daily activities for 10 days. Neurological examination showed mild weakness on the right side, with power of 4/5 in the right upper and lower limbs, while the left-sided limb power was normal.

Neuroimaging showed a left frontoparietal chronic subdural hematoma, which is a collection of blood between the brain surface and its outer covering. The condition was causing pressure on the brain and contributing to symptoms such as walking difficulty, recurrent falls, and cognitive slowing.

The patient also had a history of PTCA with stenting in the past and was on antiplatelet therapy, which was stopped before surgery as advised. Based on the confirmed diagnosis, the patient was advised to undergo Left Frontoparietal Chronic Subdural Hematoma Treatment in Hyderabad, India, under the expert care of the Neurosurgery Department.

After a detailed consultation with Dr. U. L. Sandeep Varma (Consultant Neurosurgeon), a comprehensive evaluation was conducted focusing on the patient’s complaints of forgetfulness, slowness of walking, multiple falls, and restriction in daily activities for 10 days.

Clinical examination and neurological assessment were reviewed. The patient had mild weakness on the right side, with power of 4/5 in the right upper and lower limbs, while the left-sided limb power was normal. CT brain findings showed a left frontoparietal chronic subdural hematoma, with features suggestive of acute-on-chronic subdural hemorrhage causing pressure over the brain.

The patient also had a history of PTCA with stenting in the past and was on dual antiplatelet therapy, advised to stop before surgery. After pre-anaesthetic clearance and clinical review, it was determined that Burr Hole and Evacuation of Hematoma under general anaesthesia was considered the most appropriate treatment to remove the blood collection, reduce pressure over the brain, improve walking difficulty and cognitive symptoms, and prevent further neurological deterioration.

The patient and family were counselled in detail regarding the diagnosis, need for surgery, possible risks, postoperative ICU monitoring, drain care, wound care, medication adherence, activity restrictions, warning signs such as fever, seizures, loss of consciousness, bleeding or paralysis, and the importance of regular follow-up.

Following the decision, the patient was scheduled to undergo Burr Hole and Evacuation of Hematoma Procedure in Hyderabad at PACE Hospitals under the expert supervision of the Neurosurgery Department.

The procedure involved the following steps:

• Anaesthesia and Positioning: The patient was administered general anaesthesia and positioned appropriately for left frontoparietal cranial access. Standard monitoring and strict aseptic precautions were followed throughout the procedure.

• Surgical Preparation and Burr Hole Creation: The operative area was cleaned, painted, and draped under sterile precautions. Two burr holes were made, one in the left frontal region and one in the left parietal region, to access the chronic subdural hematoma.

• Dural Opening and Hematoma Evacuation: The dura was carefully incised and cauterized. The chronic subdural hematoma was evacuated from the left frontoparietal region to reduce pressure over the brain.

• Irrigation and Drain Placement: The subdural space was gently washed until clear fluid was obtained, ensuring adequate evacuation of the hematoma. An 8 Fr feeding tube drain was inserted to allow postoperative drainage.

• Wound Closure: After confirming hemostasis, the wound was closed using nylon sutures, and a sterile dressing was applied. The procedure was completed successfully, and the patient was shifted for postoperative monitoring.
  

Postoperatively, the patient was monitored closely for neurological status, wound condition, drain output, seizures, bleeding, and signs of raised intracranial pressure. After the Burr Hole and Evacuation of Hematoma procedure, the patient was kept in the ICU for 6 hours for observation and was later shifted to the ward after stabilization.

The subdural drain was removed on postoperative day 2 after satisfactory recovery. The patient remained stable during the hospital stay and showed good postoperative improvement. Wound care was continued, and the patient was advised to avoid strenuous activity during the recovery period.

Postoperative CT brain showed expected left frontoparietal burr hole changes with drain placement and residual extra-axial collection, suggestive of acute-on-chronic subdural hemorrhage. The patient was discharged in stable condition with advice to follow medications and attend regular follow-up.

Upon discharge, the patient was prescribed medications for the prevention of postoperative infection, seizure prevention, gastric protection, neurological support, wound care, and continuation of cardiac-related medication as advised.

The patient was advised to take the prescribed medications strictly as instructed and maintain proper wound care by keeping the surgical site clean and dry. He was instructed to avoid strenuous activity, heavy lifting, sudden bending, and activities that may increase the risk of falls or head injury.

The patient was instructed to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as fever, seizures, loss of consciousness, bleeding from the wound, sudden weakness or paralysis, worsening confusion, severe headache, repeated vomiting, or any new neurological symptoms.

The patient was advised to return for follow-up with the Neurosurgeon in Hyderabad at PACE Hospitals after 11 days for suture removal and postoperative review.

This case highlights left frontoparietal chronic subdural hematoma in a 70-year-old male patient who presented with forgetfulness, slowness of walking, multiple falls, and restriction in daily activities. The condition was effectively managed with burr hole and evacuation. The patient recovered well after surgery, the drain was removed on postoperative day 2, and he was discharged in stable condition with appropriate follow-up advice.