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Patterns of care: burr-hole cover application for chronic subdural hematoma trepanation
EANS Academy. Vasella F. Sep 27, 2019; 275990; EP05058
Flavio Vasella
Flavio Vasella

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Abstract
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Background: Skin depressions may appear as undesired effects after burr-hole trepanation for the evacuation of chronic subdural hematomas (cSDH). Placement of burr-hole covers to reconstruct skull defects can prevent skin depressions, with the potential to improve the aesthetic result and patient satisfaction. The perception on its relevance appears to vary substantially among neurosurgeons. We aimed to identify current practice variations with regards to the application of burr-hole covers.
Methods: An electronic survey was sent to resident and faculty neurosurgeons practicing in different parts of the world. All completed responses between 09/2018 and 12/2018 were considered. Descriptive statistics and logistic regression were used.
Results: A total of 604 responses were obtained, of which 576 (95.4%) provided complete data. Respondents had a mean age of 42.4 years, 86.5% were male. The sample consisted of residents, fellows, junior/senior consultants, and department chairs from 79 countries (77.4% Europe, 11.8% Asia, 5.4% America, 3.5% Africa, 1.9% Australasia). Skin depressions were considered a relevant issue by 31.6% and 76.0% indicated that patients complain about skin depressions more or less frequently. Burr-hole covers are placed by 28.1% in the context of cSDH evacuation more or less frequently. The most frequent reasons for not placing a burr-hole cover were the lack of proven benefit (34.8%), followed by additional costs (21.9%) and technical difficulty (19.9%). Most (77.5%) stated that they would consider placing burr-hole covers in the future, if there was evidence for its superiority. The use of burr-hole covers varied substantially across countries, but a countries' gross domestic product per capita was not associated with its placement.
Conclusions: Only a minority of neurosurgeons' places burr-hole covers after trepanation for cSDH on a regular basis, even though the majority of participants reported complaints from patients regarding postoperative skin depressions. There are significant differences in the patterns of care among countries.
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