A burr hole procedure is a brain surgery that is often done after mild to severe head injuries.
In this procedure, a brain surgeon drills a small hole in your skull to drain blood from your brain. This blood can cause pressure and compress your brain tissue, which can lead to damage and death.
Your brain is protected by the hard outer bones of your skull and three layers of tissue called meninges. The outermost layer is the dura mater, the middle layer is the arachnoid mater, and the layer closest to the brain is the pia mater.
A burr hole opens access to the dura mater. Sometimes your doctor will use this hole as the first step to other procedures on your brain.
Is a Burr Hole a Craniotomy?
A craniotomy is a surgical procedure where your doctor temporarily removes a piece of your skull called a bone flap. A part of your skull is also removed during a burr hole procedure, making it technically a type of craniotomy. However, it's usually labeled as a separate procedure.
Why Do You Need Burr Hole Surgery?
The most common reason for a burr hole procedure is to treat a sudden or ongoing subdural hematoma. This is a condition where blood collects between the dura mater and the arachnoid mater and usually happens after mild or severe injuries. It can be life-threatening.
A subdural hematoma can also happen for other reasons, including:
- Head injury from shaken baby syndrome
- Hitting your head during a fall or violence
- Medicines that prevent clots, like warfarin
- Getting tackled in sports
- Getting older, which causes brain shrinking called atrophy
- Drinking too much alcohol, which can cause blood vessels to shrink and rupture
- Brain tumor
- Previous brain injury
- Bleeding disorders like hemophilia
A burr hole procedure allows your doctor to drill holes in your skull to relieve pressure from fluid or blood buildup.
Sometimes your doctor will drill a burr hole to do a procedure called a neuroendoscopy. Once the holes are drilled, they will insert a scope with a camera and special instruments to perform brain surgery. A neuroendoscopy is considered a less invasive way to work on your brain. Your doctor can do this to remove brain tumors or cysts.
How Is a Burr Hole Procedure Done?
Before starting any surgery, your doctor will take pictures of your brain using computed tomography (CT) scan or magnetic resonance imaging (MRI). It will give them information about the fluid around your brain.
Before the burr hole procedure, you will get anesthesia intravenously (through your vein) to help you relax. The area where the hole will be made is shaved and numbed with pain medication. You might be awake for the procedure or you might have general anesthesia and be asleep.
The surgeon will make a small cut on your scalp and drill a small hole about the size of a dime in your scalp. If they’re only draining fluid, your surgeon will make a small cut in the dura mater and place a rubber tube to help remove the fluid. In some cases, they might leave the drain in place to help keep fluid off your brain.
If you’re having a neuroendoscopy, the surgeon will insert a scope and camera and continue working. They might cover the burr hole with a metal plate.
What Are the Risks of Burr Hole Surgery?
All surgeries have risks and can lead to complications like death. Some risks for burr hole surgery can include:
- Infection
- Bleeding
- Blood clot
- Brain injury
- Stroke
- Heart attack
- Fluid builds up again, and you need more brain surgery
If you are older or have other health problems, you might have a higher chance of risks. Your doctor will talk about the risks and benefits with you before you have the procedure. In some cases, it might be an emergency procedure to save your life.
How Long Is the Burr Hole Surgery Recovery?
Burr hole surgery recovery takes time. You’ll stay at a hospital for a few days after the surgery. Your doctor will carefully watch your vital signs and make sure you respond well to the procedure.
It’s common to feel pain where the holes were drilled, but your doctor will give you some pain medication. You won’t be able to drive after the procedure until your doctor clears it.
It’s important to keep your doctor appointments after your procedure.
