Emergent Burr Hole Drainage of Traumatic Acute Subdural Hematoma with Drain Placement in Preexisting Coagulopathy Showing Rapid Neurological Deterioration: A Novel Technique

Abstract

Aim The aim of this article is to investigate the efficacy of emergency burr hole drainage of significantly thicker acute subdural hematoma (ASDH) with coagulopathy.

Patient and Methods A 23-year-old man presented with ASDH of left fronto-temporo-parietal region due to trauma following trivial injury. Patient was chronic alcoholic having coagulopathy and thrombocytopenia. He had rapid deterioration in neurological status. Though craniotomy and hematoma evacuation was planned initially, in view of persistent coagulopathy, emergent burr hole evacuation was performed. Neurological symptoms improved dramatically after the burr hole evacuation. He became alert and could walk unassisted 3 days after surgery, although psychic disturbance resulting from cerebral contusion persisted.

Result Burr hole evacuation is an useful treatment for significant thicker ASDH with coagulopathy, as procedure can be performed easily and rapidly, aids in achieving reduction of intracranial pressure while purchasing time for correction of coagulopathy.

Conclusion Emergency burr hole drainage should be considered in rapidly deteriorating patients with significant thicker ASDH with persistent thrombocytopenia and coagulopathy showing rapid neurological deterioration.

Keywords

acute subdural hematoma - burr hole drainage - coagulopathy - thrombocytopenia

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