Post-Operative Outcomes of Single Versus Double Bur-Hole Technique in Patients with Chronic Subdural Hematoma

Abstract

Background: Chronic subdural hematoma (CSDH) is a common neurosurgical condition with increasing incidence in elderly populations and patients with coagulopathies or minor head trauma. Surgical evacuation via burr-hole drainage is the standard of care, yet the optimal technique—single versus double burr-hole—remains debated due to conflicting evidence on recurrence and complication rates. Objective: To compare the post-operative outcomes of single versus double burr-hole drainage in patients with CSDH and to identify predictors of recurrence, seizures, and prolonged hospital stay. Methods: A prospective cohort study was conducted at Bolan Medical College and BMCH Quetta from December 2023 to June 2024. Adult patients with radiologically confirmed CSDH were randomized to undergo either single or double burr-hole drainage. Baseline demographics, clinical characteristics, and outcomes were recorded prospectively. Primary outcomes included hematoma recurrence, postoperative seizures, mortality, and length of hospital stay. Statistical analysis employed chi-square, t-tests, and multivariate logistic regression, with p≤0.05 considered significant. Results: Ninety-six patients were enrolled (n=48 per group; 66.7% male; mean age 62±13.7 years). Recurrence rates were 29.2% in the single burr-hole group versus 20.8% in the double burr-hole group (p=0.34). Seizures occurred in 16.7% and 10.4% respectively (p=0.37). No deaths occurred. Lower preoperative GCS and bilateral hematomas were significant predictors of seizures and longer hospitalization (p<0.01). Conclusion: Single and double burr-hole drainage techniques yielded comparable postoperative outcomes for CSDH. Single burr-hole drainage may be favored for its reduced invasiveness, with preoperative neurologic status and hematoma laterality more strongly influencing prognosis.