Name of the Procedure:

Burr hole(s); with aspiration of hematoma or cyst, intracerebral

Summary

A burr hole procedure involves drilling a small hole in the skull to access the brain. This is typically done to drain accumulated blood (hematoma) or fluid-filled cysts within the brain to relieve pressure and avoid damage.

Purpose

This procedure addresses conditions like intracerebral hematomas (brain bleeding) or cysts that cause increased intracranial pressure. The goal is to evacuate the blood or fluid, reducing pressure on the brain, and preventing further neurological damage.

Indications

• Symptoms like severe headache, confusion, slurred speech, or altered consciousness.
• Diagnosed intracerebral hematomas or cysts via imaging (CT scan, MRI).
• Rapid deterioration in neurological function due to increased intracranial pressure.

Preparation

• Fasting for several hours before the procedure.
• Adjustments or cessation of certain medications as advised by the healthcare provider.
• Preoperative imaging studies (CT or MRI scans) to locate the hematoma or cyst.

Procedure Description

1. Administration of general anesthesia.
2. Shaving and disinfecting the area of the scalp where the hole will be made.
3. Making a small incision in the scalp.
4. Drilling a burr hole through the skull using specialized tools.
5. Inserting a catheter or aspirating device to drain the hematoma or cyst fluid.
6. Closing the incision with sutures or staples.

Tools and Equipment:

• Drill with a specialized bit for creating burr holes.
• Catheters or aspiration needles for drainage.
• Imaging guidance tools (sometimes intraoperative CT or MRI).

Duration

The procedure typically takes 1 to 2 hours.

Setting

Typically performed in a hospital operating room.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurse
• Surgical technician

Risks and Complications

• Infection at the incision site
• Bleeding or additional hematoma formation
• Neurological damage or deficits
• Swelling or increased intracranial pressure post-procedure
• Adverse reaction to anesthesia

Benefits

• Relief from symptoms caused by increased intracranial pressure.
• Prevention of further brain damage.
• Improved neurological function and potentially life-saving in emergency situations. Expected benefits can typically be seen within hours to days post-procedure.

Recovery

• Post-procedure monitoring in an intensive care unit (ICU) for at least 24 hours.
• Pain management with medications.
• Instructions to avoid strenuous activities and heavy lifting for a specified period.
• Follow-up imaging tests to ensure successful drainage and no re-accumulation of fluid.
• Regular follow-up appointments with the neurosurgeon.

Alternatives

• Medications to reduce brain swelling (not always sufficient for large hematomas/cysts).
• Less invasive procedures like stereotactic aspiration.
• Observation for small, asymptomatic cysts or hematomas.

Patient Experience

Patients usually experience minimal discomfort during the procedure due to general anesthesia. Post-procedure, there may be some pain or discomfort at the site of the incision, which is managed with pain medications. Patients may feel weak or groggy but will progressively feel better as the brain pressure normalizes.