Burr Hole Trepanation for Chronic Subdural Hematomas: Is Surgical Education Safe?

Aim: To investigate the safety and efficacy of surgical education for neurosurgical residents in the evacuation of chronic subdural hematomas (cSDH) by burr hole trepanation.

Methods: This is a retrospective analysis of prospectively collected data on consecutive patients receiving burr hole trepanation for uni- or bilateral cSDH. Patients operated by a supervised neurosurgery resident (teaching cases) were compared with patients operated by a board-certified faculty neurosurgeon (nonteaching cases). The primary end point was surgical revision for any reason until last follow-up. The secondary end point was occurrence of any complication until last follow-up. Clinical status, type of complications, mortality, length of surgery (LOS), and hospitalization (LOH) were tertiary end points.

Results: A total of n = 253 cases were analyzed, of which n = 217 (85.8%) were teaching and n = 36 (14.2%) nonteaching cases. The study groups were balanced in terms of age, sex, surgical risk (ASA score), and preoperative status (Karnofsky Performance Scale, modified Rankin Scale, National Institute of Health Stroke Scale). The cohort was followed for a mean of 242 days (standard deviation 302). In multivariate analysis, teaching cases were as likely as nonteaching cases to require revision surgery (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.27—1.59, p = 0.348) as well as to experience any complication until last follow-up (OR 0.79, 95% CI 0.37–1.67, p = 0.532). Mean LOS was about 10 minutes longer in teaching cases (53.0 ± 26.1 min vs 43.5 ± 17.8 min, p = 0.036), but LOH was similar. There were no group differences in clinical status, mortality, and type of complication at discharge and last follow-up.

Conclusions: Burr hole trepanation for cSDH can be safely performed by supervised neurosurgical residents enrolled in a structured training program, without increasing the risk for revision surgery, perioperative complications, or worse outcome.