{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T09:20:32Z","timestamp":1770888032039,"version":"3.50.1"},"reference-count":33,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2011,11]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Various surgical interventions have been described to evacuate chronic subdural collections (CSCs) of infancy. These include transfontanel percutaneous aspiration, subdural drains, placement of bur hole(s) with or without a subdural drain, and shunting. Shunt placement typically provides good long-term success (resolution of the subdural fluid), but comes with well-known early and late complications. Recently, the authors have used a mini\u2013osteoplastic craniotomy technique with the goal of definitively treating these children with a single surgery while avoiding the many issues associated with a shunt. They describe their procedure and compare it with the traditional bur hole technique.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>In this single-institution retrospective study, the authors evaluated 26 cases involving patients who underwent treatment for CSC. Preoperative, intraoperative, and postoperative data were reviewed, including radiographic findings (density of the subdural fluid and ventricular and subarachnoid space size), neurological examination findings, and intraoperative fluid description. The primary outcome was treatment failure, defined as the patient requiring any subsequent surgical intervention after the index procedure (minicraniotomy or bur hole placement).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Fifteen patients (10 male and 5 female; median age 5.1 months) collectively underwent 27 minicraniotomy procedures (each procedure representing a hemisphere that was treated). In the bur hole group, there were 11 patients (6 male and 5 female; median age 4.6 months) with 18 hemispheres treated. Both groups had subdural drains placed. The average follow-up for each treatment group was just over 7 months. Treatment failure occurred in 2 patients (13%) in the minicraniotomy group compared with 5 patients (45%) in the bur hole group (p = 0.09). Furthermore, the 2 patients who had treatment failure in the minicraniotomy group required 1 subsequent surgery each, whereas the 5 in the bur hole group needed a total of 9 subsequent surgeries. Eventually, 80% of the patients in the minicraniotomy group and 70% of those in the bur hole group had resolution of the subdural collections on the last imaging study.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The minicraniotomy technique may be a superior technique for the treatment of CSCs in infants compared with bur hole evacuation. The minicraniotomy provides greater visualization of the subdural space and allows more aggressive evacuation of the fluid, better irrigation of the space, the ability to fenestrate any accessible membranes safely, and continued egress of fluid into the subgaleal space. Although this preliminary report has obvious limitations, evaluation of this technique may be worthy of a prospective, multiinstitutional collaborative effort.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2011.8.peds1131","type":"journal-article","created":{"date-parts":[[2011,11,1]],"date-time":"2011-11-01T14:58:56Z","timestamp":1320159536000},"page":"423-429","source":"Crossref","is-referenced-by-count":14,"title":["Minicraniotomy versus bur holes for evacuation of chronic subdural collections in infants\u2014a preliminary single-institution experience"],"prefix":"10.3171","volume":"8","author":[{"given":"Paul","family":"Klimo","sequence":"first","affiliation":[{"name":"Le Bonheur Children's Hospital, and"},{"name":"Semmes-Murphey Neurologic & Spine Institute, Memphis, Tennessee;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Matthews","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean M.","family":"Lew","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marike","family":"Zwienenberg-Lee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California\u2013Davis, Sacramento, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruce A.","family":"Kaufman","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-0080423","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"794","DOI":"10.1227\/01.NEU.0000298908.94129.67","article-title":"The role of postoperative patient posture in the recurrence of traumatic chronic subdural hematoma after burr-hole surgery","volume":"61","author":"Abouzari","year":"2007"},{"key":"b2-0080423","series-title":"Neurosurg Rev","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1007\/s10143-009-0215-3","article-title":"Chronic subdural hematoma outcome prediction using logistic regression and an artificial neural network","volume":"32","author":"Abouzari","year":"2009"},{"key":"b3-0080423","series-title":"Childs Brain","first-page":"79","article-title":"Subdural effusion: results after treatment with subdural-pleural shunts","volume":"3","author":"Arsalo","year":"1977"},{"key":"b4-0080423","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1007\/s00701-002-0947-0","article-title":"Surgical treatment of chronic subdural hygromas in infants and children","volume":"144","author":"Caldarelli","year":"2002"},{"key":"b5-0080423","series-title":"Can J Neurol Sci","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1017\/S0317167100004510","article-title":"Management of chronic subdural hematoma: a national survey and literature review","volume":"32","author":"Cenic","year":"2005"},{"key":"b6-0080423","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/j.jocn.2003.09.012","article-title":"Irrigation vs. closed drainage in the treatment of chronic subdural hematoma","volume":"12","author":"Erol","year":"2005"},{"key":"b7-0080423","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1007\/s003810050131","article-title":"Continuous external subdural drainage in the management of infantile subdural collections: a prospective study","volume":"13","author":"Er\u015fahin","year":"1997"},{"key":"b8-0080423","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1007\/PL00007288","article-title":"Complications of subduroperitoneal shunting","volume":"16","author":"Ersahin","year":"2000"},{"key":"b9-0080423","series-title":"Pediatr Neurosurg","first-page":"121","article-title":"Continuous external drainage in the treatment of subdural hematomas of infancy","volume":"17","author":"Gaskill","year":"1992"},{"key":"b10-0080423","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/j.surneu.2005.05.030","article-title":"Bedside twist drill craniostomy for chronic subdural hematoma: a comparative study","volume":"65","author":"Horn","year":"2006"},{"key":"b11-0080423","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"590","DOI":"10.1007\/s003810000312","article-title":"Infantile head injury, with special reference to the development of chronic subdural hematoma","volume":"16","author":"Hwang","year":"2000"},{"key":"b12-0080423","series-title":"J Pediatr Surg","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1053\/jpsu.2000.9328","article-title":"Subduralatrial and subdural-peritoneal shunting in infants with chronic subdural fluid collections","volume":"35","author":"Korinth","year":"2000"},{"issue":"3 Suppl","key":"b13-0080423","series-title":"J Neurosurg","first-page":"172","article-title":"Factors influencing the complication rate of subduroperitoneal shunt placement for the treatment of subdural hematomas in infants","volume":"106","author":"Kurschel","year":"2007"},{"key":"b14-0080423","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"796","DOI":"10.3171\/jns.2000.93.5.0796","article-title":"Chronic subdural hematoma: evaluation of the clinical significance of postoperative drainage volume","volume":"93","author":"Kwon","year":"2000"},{"key":"b15-0080423","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"615","DOI":"10.3171\/2009.9.JNS08825","article-title":"Choosing the best operation for chronic subdural hematoma: a decision analysis. Clinical article","volume":"113","author":"Lega","year":"2010"},{"key":"b16-0080423","series-title":"J Trauma","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1097\/01.TA.0000093364.61197.77","article-title":"External subdural drainage in the treatment of infantile chronic subdural hematoma","volume":"57","author":"Lin","year":"2004"},{"key":"b17-0080423","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1227\/00006123-199209000-00009","article-title":"Management of symptomatic chronic extra-axial fluid collections in pediatric patients","volume":"31","author":"Litofsky","year":"1992"},{"key":"b18-0080423","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1016\/j.surneu.2004.06.023","article-title":"Influence of head position on the effectiveness of twist drill craniostomy for chronic subdural hematoma","volume":"63","author":"Miele","year":"2005"},{"key":"b19-0080423","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1007\/s00381-002-0596-x","article-title":"Managing subdural fluid collection in infants","volume":"18","author":"Miyake","year":"2002"},{"key":"b20-0080423","series-title":"Br J Neurosurg","doi-asserted-by":"publisher","first-page":"612","DOI":"10.3109\/02688690903370297","article-title":"Chronic subdural hematoma\u2014craniotomy versus burr hole trepanation","volume":"23","author":"Mondorf","year":"2009"},{"key":"b21-0080423","series-title":"J Neurosurg Sci","first-page":"41","article-title":"Chronic subdural hematoma: comparison of two surgical techniques. Preliminary results of a prospective randomized study","volume":"49","author":"Muzii","year":"2005"},{"key":"b22-0080423","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"791","DOI":"10.3171\/jns.2000.93.5.0791","article-title":"Relationship between drainage catheter location and postoperative recurrence of chronic subdural hematoma after burr-hole irrigation and closed-system drainage","volume":"93","author":"Nakaguchi","year":"2000"},{"key":"b23-0080423","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1016\/S0140-6736(09)61115-6","article-title":"Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial","volume":"374","author":"Santarius","year":"2009"},{"key":"b24-0080423","series-title":"Br J Neurosurg","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1080\/02688690701818885","article-title":"Number of burr holes as independent predictor of postoperative recurrence in chronic subdural haematoma","volume":"22","author":"Taussky","year":"2008"},{"key":"b25-0080423","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1159\/000055952","article-title":"Outcome of surgical treatment for subdural fluid collections in infants","volume":"33","author":"Tolias","year":"2000"},{"key":"b26-0080423","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1125","DOI":"10.1227\/01.NEU.0000335782.60059.17","article-title":"Independent predictors for recurrence of chronic subdural hematoma: a review of 343 consecutive surgical cases","volume":"63","author":"Torihashi","year":"2008"},{"key":"b27-0080423","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1007\/PL00007287","article-title":"Long-term external drainage for subdural collections in infants","volume":"16","author":"Van Calenbergh","year":"2000"},{"key":"b28-0080423","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1007\/s00381-010-1105-2","article-title":"Subdural hematoma in infants: can it occur spontaneously? Data from a prospective series and critical review of the literature","volume":"26","author":"Vinchon","year":"2010"},{"issue":"6 Suppl","key":"b29-0080423","series-title":"J Neurosurg","first-page":"383","article-title":"Postmeningitis subdural fluid collection in infants: changing pattern and indications for surgery","volume":"104","author":"Vinchon","year":"2006"},{"key":"b30-0080423","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"249","DOI":"10.3171\/jns.2001.95.2.0249","article-title":"Subduroperitoneal drainage for subdural hematomas in infants: results in 244 cases","volume":"95","author":"Vinchon","year":"2001"},{"key":"b31-0080423","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1136\/jnnp.74.7.937","article-title":"Outcome of contemporary surgery for chronic subdural haematoma: evidence based review","volume":"74","author":"Weigel","year":"2003"},{"key":"b32-0080423","series-title":"Br J Neurosurg","doi-asserted-by":"publisher","first-page":"606","DOI":"10.3109\/02688690903386983","article-title":"Prolonged drainage reduces the recurrence of chronic subdural hematoma","volume":"23","author":"Yu","year":"2009"},{"key":"b33-0080423","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1116","DOI":"10.1227\/01.NEU.0000345633.45961.BB","article-title":"Chronic subdural hematomas treated by burr hole trepanation and a subperiostal drainage system","volume":"64","author":"Zumofen","year":"2009"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/8\/5\/article-p423.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/8\/5\/article-p423.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/8\/5\/article-p423.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T15:57:05Z","timestamp":1681574225000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/8\/5\/article-p423.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2011,11]]},"references-count":33,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2011.8.peds1131","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,11]]}}}