Effectiveness of Single Versus Double Burr Hole for Chronic Subdural Hematoma: A Randomized Controlled Trial

Objective: Burr-hole craniostomy is a common surgical intervention for patients with chronic subdural hematoma (cSDH). Single burr hole craniostomy (SBHC) and double burr hole craniostomy (DBHC) are widely practiced techniques; however, debate continues regarding the superior approach owing to limited comparative literature. This study aimed to compare the clinical outcomes, complications, and recurrence rates between SBHC and DBHC in patients with cSDH. Methods: This prospective, open-label, non-inferiority, randomized controlled trial was conducted at the AIIMS Patna. Sixty-six patients with cSDH were enrolled in this study and randomized to either SBHC or DBHC. Assessments were performed before surgery and at 1 week and one month after surgery. Preoperatively, no differences were observed in the non-contrast computed tomography scans, Glasgow Coma Scale scores, ventilator/intensive care unit days, recurrence, or complications. Statistical analysis was done using SPSS v22.0. Results: =0.13 and 0.07, respectively). Neurological improvements and radiological outcomes showed similar trends. The difference in the non-recurrence rate (11.01%) remained within the non-inferiority margin (11.5%). Conclusion: Both SBHC and DBHC were effective in evacuating cSDH. SBHC was shown to be non-inferior to DBHC, but had a slight increase in the recurrence rate and ventilator time. Based on patient characteristics, SBHC may be a simple and less invasive treatment option. Trial Registration: International Standard Randomised Controlled Trial Number Identifier: ISRCTN53688663.