Name of the Procedure:

Burr Hole(s) or Trephine; with Biopsy of Brain or Intracranial Lesion

Summary

A Burr hole or trephine procedure involves creating a small hole in the skull to obtain a tissue sample (biopsy) from the brain or an intracranial lesion. This minimally invasive approach allows doctors to diagnose and treat conditions affecting the brain.

Purpose

• Medical Condition: This procedure is primarily used to diagnose abnormalities such as tumors, infections, or inflammatory conditions within the brain.
• Goals/Outcomes: The main goal is to obtain a precise and accurate tissue sample for pathological examination, which helps in planning appropriate treatment strategies.

Indications

• Persistent headaches
• Seizures
• Changes in vision or speech
• Neurological deficits
• Unexplained symptoms that brain imaging (CT or MRI) suggests may be related to a brain lesion

Preparation

• Pre-procedure Instructions: Patients may need to fast for 8 hours prior to the procedure.
• Medications: Adjustments to current medications, particularly blood thinners, need to be discussed with the healthcare provider.
• Diagnostic Tests: Preoperative imaging such as MRI or CT scans, routine blood tests, and neurological assessments.

Procedure Description

1. Anesthesia: General anesthesia is usually administered.
2. Positioning: The patient’s head is securely positioned in a headholder.
3. Incision: A small incision is made in the scalp over the area of interest.
4. Burr Hole Creation: A high-speed drill is used to create a small hole in the skull.
5. Biopsy: Specialized tools are inserted through the hole to carefully extract a tissue sample from the brain or lesion.
6. Closure: The incision is then closed with sutures or staples.

Duration

The procedure typically takes about 1-2 hours.

Setting

The procedure is performed in a hospital operating room equipped with advanced surgical and imaging technology.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Common Risks: Bleeding, infection, nausea, headache
• Rare Risks: Stroke, seizures, damage to surrounding brain tissue, neurological deficits

Benefits

• Accurate diagnosis of brain lesions
• Targeted treatment plans based on biopsy results
• Minimized risk compared to more invasive surgical approaches

Recovery

• Post-Procedure Care: Monitoring in the recovery room for a few hours to overnight stay.
• Recovery Time: Generally, patients may resume light activities in a few days, but complete recovery might take a few weeks.
• Follow-Up: Follow-up appointments for result discussion and further treatment planning are necessary.

Alternatives

• Non-Surgical: Advanced imaging techniques such as MRI spectroscopy, PET scans.
• Other Surgical: Stereotactic needle biopsy, open craniotomy.
• Pros and Cons: Non-surgical methods are less invasive but may not provide as definitive a diagnosis; open craniotomies provide more extensive access but come with higher risks.

Patient Experience

• During the Procedure: Patients are under general anesthesia and will not feel any pain.
• After the Procedure: Some discomfort or headache is common post-procedure, managed with prescribed pain medications. Instructions for caring for the incision site and activity restrictions will be given to promote healing and reduce risks.