61154 Burr hole(s) with evacuation and/or drainage of hematoma, extradural or subdural

Name of the Procedure:

Burr Hole(s) with Evacuation and/or Drainage of Hematoma (Extradural or Subdural)

Summary

A burr hole procedure involves drilling a small hole into the skull to relieve pressure caused by a hematoma, which is a collection of blood that has leaked outside of blood vessels, either above (extradural) or below (subdural) the dura mater, the outer membrane covering the brain.

Purpose

This procedure addresses conditions where blood has accumulated and is causing increased pressure on the brain. The main goal is to alleviate this pressure to prevent brain damage and improve patient outcomes.

Indications

The procedure is generally indicated for patients experiencing symptoms like severe headache, confusion, weakness, loss of consciousness, or other neurological deficits due to brain compression from a hematoma. It is suitable for those diagnosed with extradural or subdural hematomas from trauma, aneurysm rupture, or other causes.

Preparation

• Patients may need to fast for several hours before the procedure.
• Medications that affect blood clotting might need to be adjusted.
• Pre-procedure diagnostics can include CT scans or MRIs to locate and assess the size of the hematoma.

Procedure Description

1. The patient is typically given general anesthesia.
2. The surgeon makes an incision in the scalp over the affected area.
3. A small hole is drilled into the skull using a specialized drill.
4. The blood clot or hematoma is then evacuated through the burr hole, often using suction.
5. Drainage tubes may be inserted to continue draining any remaining blood.
6. The surgical area is closed and bandaged.

Duration

The procedure usually takes between 1 to 2 hours, depending on the complexity and size of the hematoma.

Setting

This procedure is performed in a hospital operating room under sterile conditions.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical Nurse
• Operating Room Technician

Risks and Complications

Common risks include infection, bleeding, and reactions to anesthesia. Rare complications might involve damage to brain tissues, seizures, or re-accumulation of blood requiring additional surgery.

Benefits

The primary benefit is the reduction of pressure on the brain, which can prevent permanent brain damage and improve neurological function. Relief of symptoms often occurs relatively quickly after the procedure.

Recovery

Post-procedure care typically involves monitoring in an intensive care unit (ICU). Patients may need to rest and avoid strenuous activities for weeks to months. Follow-up appointments are crucial for assessing recovery and preventing complications.

Alternatives

• Conservative management with observation and medications, which may be suitable for smaller, non-life-threatening hematomas.
• More extensive surgical interventions might be needed for larger or more complex hematomas but come with higher risks.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel pain. Post-procedure, there may be discomfort at the incision site, managed with pain medications. Patients might feel groggy from anesthesia but can expect to gradually regain normal function as the brain pressure decreases.