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Burr Hole

Burr holes are small holes drilled into the skull to relieve pressure from fluid buildup and brain compression. They are indicated for epidural or subdural hematomas with midline brain shift seen on imaging and unequal pupils. Contraindications include a Glasgow Coma Scale over 8 and availability of prompt neurosurgery. The procedure involves drilling a hole in the skull at the site of fluid collection and draining any blood or fluid present.

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530 views3 pages

Burr Hole

Burr holes are small holes drilled into the skull to relieve pressure from fluid buildup and brain compression. They are indicated for epidural or subdural hematomas with midline brain shift seen on imaging and unequal pupils. Contraindications include a Glasgow Coma Scale over 8 and availability of prompt neurosurgery. The procedure involves drilling a hole in the skull at the site of fluid collection and draining any blood or fluid present.

Uploaded by

rachelmores12
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Burr hole

Burr holes are small holes that a neurosurgeon makes in the skull. Burr holes

are used to help relieve pressure on the brain when fluid, such as blood, builds

up and starts to compress brain tissue.

Indications
 Epidural or subdural hematoma with midline shift on imaging and unequal pupils on exam.[3]
 GCS <8
 Anticipated extended time to assessment/treatment by neurosurgeon.

Contraindications
 GCS >8
 Neurosurgery available in reasonable timeframe
 Lack of imaging-confirmed epidural or subdural hematoma
o In absence of imaging (e.g. in rural/wilderness area at facility without CT availability), very high
clinical suspicion may be enough.[3]
 e.g. evidence of severe head trauma and unequal pupils, patient presents awake and talking but
rapidly deteriorates in setting of head trauma and unequal pupils, etc.

Equipment Needed
 Cranial access kit
o Razor
o Scalpel
o Self-retaining retractors
o Drill (manual or air/electric powered)
 Should have both sharp (penetrator) and dull drill bits or a drill bit with appropriate "clutch"
mechanism (preferred)
o Blunt and sharp hooks
o Hemostats and forceps
 Sterile PPE
 Chlorhexidine or betadine
 Sterile saline
 Electrocautery (Bovie), if available

Procedure[3][5]

 Place patient supine


 Select optimal site based on location of hemorrhage on CT (if unsure, use temporal site)
o Temporal - 2 finger-breadths above and 2 finger-breadths forward of the auditory canal
o Parietal - over parietal eminence
o Frontal - 10 cm above eye in mid-pupillary line (about 3 cm from sagittal suture)
 Shave scalp widely over selected site
 Cleanse skin with chlorhexadine or betadine and drape in sterile fashion
 Set drill depth based on thickness of skull (as measured on CT)
 Make ~3cm incision and dissect down to bone with scalpel (control bleeding with direct pressure or
electrocautery)
 Dissect periosteum off bone with scalpel
 Apply retractors to maintain field
 Apply drill perpendicular to skull and begin drilling while applying firm pressure
o Have assistant apply gentle saline wash to drilling site
 Continue drilling until loss of resistance felt or drill bit stops spinning (when using "clutch"-type drill
bit)
 Use hooks to remove any remaining bone fragments
o Preserve skull fragments in container of sterile saline
 If subdural hematoma, elevate dura with sharp hook and make careful incision with scalpel
 Allow blood to drain freely (gentle suction may be used, but DO NOT suction brain tissue)
 Once blood flow slows/stops, apply loose dressing (DO NOT tamponade bleeding)

Disposition
 Provide ceftriaxone IV for antibiotic prophylaxis after procedure
 Transfer immediately to facility with appropriate ICU and neurosurgical capability

Complications
 Bleeding
 Infection
 Damage to brain parenchyma

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