Burr Hole – evacuation of right frontoparietal chronic Sub Dural Hematoma and left parietal SDH

Burr Hole—evacuation of right frontoparietal chronic Sub Dural Hematoma and left parietal SDH

D. Vanitha

Nursing Superintendent, Kauvery Hospital, Tirunelveli

Abstract

Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. Despite ongoing efforts, recurrence and reoperation rates after surgical treatment remain high. We synthesize scientific evidence on the treatment of CSDH with biophysical principles and then propose a simple and effective surgical technique aiming to reduce the recurrence rate.

Background

A 54 years old female, came with complaints of giddiness and headache since two days, one episode of vomiting on the morning of the day of consultation and generalized tiredness.

No H/o melena/hematemesis (-). No h/o breathlessness, pedal edema

On Examination

Patient obeying commands

PR – 90/min,

BP – 140/90 mmHg,

CVS – S1 S2 (+),

RS – Bilateral air entry present,

P/A – soft,

CNS – NFND.

Investigations

ECHO: Normal LV systolic function, stage I diastolic dysfunction, MR (Mild), TR (Mild)

Course in the hospital

A 54-year-old female admitted with complaints of giddiness and headache vomiting for past two days. All routine and relevant investigations were done, Hemoglobin 5.4, ESR 68 and iron profile taken where Ferritin level was 8.6. Peripheral smear study done which showed microcytic hypochromic anemia with thrombocytosis. Two units of PRBC blood transfusion were given on 04/05/24. USG abdomen was taken which showed normal study.

Patient suddenly became drowsy yet responding to painful stimuli, moving all four limbs. Right eye had ptosis. Voluntarily closes both the eyes. Neuro opinion was obtained and advised to do MRI brain which showed features of chronic subdural hemorrhage. Neurosurgeon opinion was obtained and planned for Surgery. Cardiologist opinion obtained for fitness for surgery. After informed consent, burr hole and evacuation of right fronto-temporo-parietal chronic SDH and Left parietal SDH was done on 10/05/2024.

Surgical Notes

Under ETGA, patient supine, two linear incision made in right frontal. Parietal region, burr hole made in the corresponding site. Left parietal incision made and burr hole made. Dura opened by cruciate incision, initially on right side and then on left side. Altered blood of about 180 ml was drained on the right side, and 40 ml on left side. Thorough ringer lactate wash given till the returns were clear. After attaining complete hemostasis, wound was closed in layers. Post procedure was uneventful. One unit whole blood transfusion was given. Post transfusion vitals stable. Patient was hemodynamically stable, and hence shifted to room. Serial drop in platelets seen. Inj. Ferium 1 dose given. Patient treated with IV Antibiotics (Inj. Ceftriaxone) analgesics, anti-epileptics (Tab. Levipil), Iron supplements & other neuroprotective drugs.

Nursing Management

After the procedure the patient was shifted to the critical unit for observation. First, monitored the patient and documented the GCS score that helped to track the patient’s neurological improvement. Then for the pain management, administered prescribed analgesics promptly to relieve pain and discomfort related to the pain. Mobilized the patient with safe and controlled mobilization, taking into consideration neurological deficits and potential risks for falls. Implemented appropriate positioning techniques, such as maintaining the head of the bed elevated, to reduce intracranial pressure and to optimize cerebral perfusion. Adhered to strict aseptic techniques during wound care and invasive procedures to reduce the risk of infection. Used clear and concise communication techniques when interacting with the patient, adapting the approach based on the patient’s cognitive abilities. Provided alternative means of communication, such as using visual aids or assistive devices, if the patient had trouble with verbal communication.

Diet

Encouraged the patient to take fruits and vegetables and high protein diet.

Medications

Drug	Dose	Frequency
Tab. Livogen		0-0-1
Tab. Aztor	20 mg	0-0-1
Tab. Levipil	500 mg	1 – 0 - 1
Tab. Panminor	40 mg	1 – 0 – 0
Tab. Stromina	500 mg	1 - 0 - 1
Tab. Pirazina	800 mg	0 – 0 - 1

Outcome of the patient

Patient discharged with good condition and vitals were stable.

D. Vanitha
Nursing Superintendent

Burr Hole – evacuation of right frontoparietal chronic Sub Dural Hematoma and left parietal SDH

Burr Hole—evacuation of right frontoparietal chronic Sub Dural Hematoma and left parietal SDH

D. Vanitha

Nightingale Journals