Management of chronic subdural hematoma (CSDH) is usually surgical; burr hole craniostomy using double burr hole under general anesthesia is the most commonly used technique for its evacuation. However, single burr hole under local anesthesia may be an alternative deserving the study. The aim of this work is to evaluate the prognosis of single burr hole under local anesthesia in the management of CSDH according to the etiology, clinical picture, surgical technique, and prognosis. We studied 67 consecutive patients with CSDH operated by single burr hole craniostomy under local anesthesia from March, 2014, to February, 2015, at Zagazig University Hospitals according to the etiology, clinical picture, surgical technique, and complications. Exclusion criteria were age below 19 years, multilocular hematomas, and uncooperative patients. This is a prospective clinical study. The age range was from 19 to 90 years with mean age of 60 years. There were 38 (56.7%) males and 29 (43.3%) females. The main cause of CSDH was old trauma in 43 (64.2%), liver disease in 14 (20.9%), antiplatelet in 8 (11.9%), and ICP hypotension in 2 (3%). Headache was found in 28 (41.8%), disturbed conscious level in 19 (25.4%), hemiparesis in 42 (62.7%), and seizure in 6 (9%). Markwalder scoring for CSDH at time of admission was 3 (4.48%) in grade 0, 20 (29.85%) in grade1, 23 (34.33%) in grade 2, 17 (25.37%) in grade 3, and 4 (5.97%) in grade 4. After evacuation, Markwalder score was 53 (79.01%) in grade 0, 13 (19.4%) in grade 1, 1 (1.50%) in grade 2, 0% in grade 3, and 0% in grade 4. Management of chronic subdural hematoma by single burr hole using local anesthesia is safe, effective, and sufficient for patient with unilocular cooperative CSDH patients with short hospital stay, low cost, and lower complication rate. ClinicalTrials.gov Identifier: NCT03447327 registered on 26 February 2018. Retrospectively registered.

中文翻译：

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局麻下单孔钻孔治疗慢性硬膜下血肿的疗效

慢性硬膜下血肿（CSDH）的治疗通常是外科手术；在全身麻醉下使用双孔钻孔开颅术是最常用的排空技术。但是，局部麻醉下的单个毛刺孔可能是值得研究的替代方法。这项工作的目的是根据病因，临床表现，手术技术和预后来评估CSDH处理中局麻下单孔的预后。我们从2014年3月至2015年2月，在Zagazig大学医院根据病因，临床表现，手术技术和并发症，对67例接受单孔颅骨开颅手术的CSDH连续患者进行了局部麻醉研究。排除标准为19岁以下，多眼血肿和不合作的患者。这是一项前瞻性临床研究。年龄范围为19至90岁，平均年龄为60岁。男38（56.7％），女29（43.3％）。CSDH的主要原因是老伤43例（64.2％），肝病14例（20.9％），抗血小板8例（11.9％）和ICP低血压2例（3％）。头痛的发生率为28（41.8％），意识障碍者为19（25.4％），偏瘫患者为42（62.7％），癫痫发作为6（9％）。入院时的CSDH的Markwalder得分为0级的3（4.48％），1级的20（29.85％），2级的23（34.33％），3级的17（25.37％）和4级的（5.97％）撤离后，Markwalder分数在0年级为53（79.01％），在1年级为13（19.4％），在2年级为1（1.50％），在3年级为0％，在4年级为0％。使用局部麻醉通过单孔钻孔治疗慢性硬膜下血肿是安全，有效的，足以满足住院时间短，成本低，并发症发生率低的单眼协作CSDH患者的需要。ClinicalTrials.gov标识符：NCT03447327，于2018年2月26日注册。已追溯注册。