Minimally Access Surgery—“Burr Hole with Very Small Craniectomy” versus “Conventional Craniotomy” for Brain Contusions: An Institutional Experience

Abstract

Objective This article aims to compare surgical outcome of brain contusions treated by “Conventional Osteoplastic/free bone flap craniotomy” (group A) with “burr hole with very small craniectomy” (group B) and evaluate for better outcomes.

Methods A total of 672 patients of brain contusions, from August 2013 through July 2014, were reviewed retrospectively from the computerized discharge summaries of the neurosurgery trauma ward. The patients with brain contusions who were treated surgically (110), were then divided into group A—“Conventional Osteoplastic/free bone flap craniotomy” (58 + 42 = 100) and group B—“burrhole with minimal craniectomy”(10).

Results Overall, 562 patients were managed conservatively. Groups were compared for demographic data, computed tomographic findings, Glasgow Coma Scale, duration of surgery, hospital stay, mortality, and Glasgow outcome scale. Mass effect on noncontrast head computed tomography was more in group A, pupillary reaction was worse. Blood loss and duration of surgery were higher in group A. Rest other parameters were not significantly different. Mortality was 11% (11/100) in group A and 0% (0/10) in group B. Overall, 48% (48/100) patients in group A and 100% (10/10) in group B had satisfactory outcome.

Conclusion “Burr hole with minimal craniectomy” in carefully selected contusion patients, who present with features of raised intracranial pressure clinically but not much radiographically, avoids a big flap. This approach minimizes blood loss and tissue handling and hence produces excellent outcome with minimal hospital stay.

Keywords

contusion - craniectomy - minimal access - burr hole

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