Burr Holes

A burr hole is a surgical procedure used to treat a subdural hematoma. In this procedure, one or more dime-sized holes is drilled into the skull to wash out blood that has built up under pressure between the brain and the skull.

Burr holes are effective at rapidly relieving pressure on the brain from a subdural hematoma. The procedure is less invasive than a craniotomy, and it tends to be used for cases in which a subdural hematoma is relatively old (chronic). Subdural hematomas that are acute (fresh) often consist of thicker clot and may need to be removed by craniotomy.

The main risk of burr holes is that a subdural hematoma can return over time - especially if the patient has another head injury. I often couple burr holes with a second endovascular (catheter-based) procedure called middle meningeal artery (MMA) embolization, which helps reduce the rate of recurrence.

The images below show a subdural hematoma (red arrow and shaded area) that is pushing on the surface of the brain. After burr holes (right image), the subdural hematoma resolved and the brain re-inflated. The patient made a complete recovery.