Understanding a Burr Hole Procedure
Burr holes are small holes that a neurosurgeon makes in the skull. Burr holes are used to help relieve pressure on the brain when fluid, such as blood, builds up and starts to press on brain tissue. This buildup of blood is dangerous. As the blood builds, it pushes up against the skull and has nowhere to go. If the blood starts to compress the brain, it can lead to symptoms or even death if not treated.
Layers around the brain
Your brain sits inside a bony skull. Inside your skull are several layers of tissue called the meninges. These layers cover and protect the brain. The layer just inside the skull is called the dura mater, or just dura. It is a tough, fibrous layer of tissue.
Why burr holes are used
One of the most common reasons burr holes are needed is for a subdural hematoma. This is when blood slowly builds up under the dura layer after a mild head injury. The veins there are fragile and easy to break, especially in older adults. This can lead to symptoms like headache, changes in behavior, seizures, and one-sided muscle weakness. If the blood continues to build, it may cause coma and brain damage.
There are other reasons why you might need a burr hole procedure. Neurosurgeons may do a burr hole procedure to relieve pressure around the brain because of:
A sudden (acute) subdural hematoma
An ongoing (chronic) subdural hematoma
Bleeding in the area around the spinal cord (epidural hematoma)
Certain kinds of brain cancer
Buildup of pus around the meninges
Buildup of cerebrospinal fluid (CSF) around the brain (hydrocephalus)
Certain kinds of bleeds from the brain itself (rare)
How a burr hole procedure is done
You will be given medicine to make you relaxed or sleep. The surgery team will trim the hair on your scalp in the area of surgery. They will inject numbing medicine into your scalp. The surgeon will make a cut (incision) in your scalp. Using a special drill, the surgeon will drill 1 or 2 small holes in the skull to reach the dura. He or she then opens the dura and drains any excess fluid. The surgeon may put a temporary drain in place to continue to drain the fluid. Or he or she may close the dura and scalp right away.
Risks of a burr hole procedure
All surgery has risks. The risks of a burr hole procedure include:
Heart attack or stroke
Problems with anesthesia
No relief from symptoms and need for a surgery such as a craniotomy
Your own risks may vary according to your age, your general health, and the reason for your procedure. Talk with your healthcare provider to find out what risks may apply to you.
May 21, 2017
Donovan, D., Cranial Burr Holes and Emergency Craniotomy: Review of Indications and Technique, Military Medicine (2006); 171(1); 12-20, Subdural hematoma in adults: Prognosis and management, Up To Date
Shelat, Amit, MD,Turley, Ray, BSN, MSN