{"id":"0d1818a4-d50c-417b-bfa1-50e2db26ecef","slug":"burr-hole-on-polyetheretherketone-cranioplasty-for-the-management-of-chronic-subdural-hematoma-a-case-report","title":"Burr hole on polyetheretherketone cranioplasty for the management of chronic subdural hematoma: A case report","authors":["Salvatore Marrone","Roberta Costanzo","Gianluca Scalia","Domenico Gerardo Iacopino","Giovanni Federico Nicoletti","Giuseppe Emmanuele Umana"],"abstract":"Background: In rare cases, chronic subdural hematoma can be a complication following cranioplasty implantation. Therefore, it can develop spontaneously or after a trauma in the underlying site of a duroplasty and represent, if compression of the brain structures, a life-threatening condition. In case of a patient with cranioplasty in polyetheretherketone (PEEK), performing a burr hole on prosthesis can represent, although unusual, an effective and safe technique for evacuation of the chronic subdural hematoma, avoiding the need to remove the prosthesis itself. Nevertheless, a rare and insidious prosthesis infection can occur, even after years. Case Description: A 54-year-old male patient, following severe traumatic brain injury, underwent a right hemispheric decompressive craniectomy associated to acute subdural hematoma evacuation and, subsequently, a PEEK cranioplasty implant with polytetrafluoroethylene (PTFE or Gore-Tex) duroplasty. About 10 years later, he experienced worsening headache with sensory alterations; therefore, he underwent a brain computed tomography scan documenting a right hemispheric chronic subdural hematoma (cSDH), expanding in subsequent radiological examinations. Because of symptoms’ worsening, he underwent cSDH evacuation through a burr hole centered on the parietal region of the PEEK prosthesis, associated with mini-reopening of duroplasty. Two years after the procedure, he went to the emergency department because of the appearance of a serum-purulent material drained from the surgical site. He underwent cranioplasty removal and then started a targeted therapy to treat a triple surgical site infection, often unpredictable and totally accidental. Conclusion: Based on the literature evidence, performing a burr hole on a cranial prosthesis in bone-like material such as PEEK represents a surgical procedure never performed before and in our opinion could, in selected cases, guarantee the cSDH evacuation and the treatment of intracranial hypertension, avoiding the cranioplasty removal, although there is a risk of even late surgical site infection.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/0d1818a4-d50c-417b-bfa1-50e2db26ecef/featured/hero-1781560923590.png","publishDate":"2022-09-30T00:00:00.000Z","doi":"10.25259/SNI_746_2022","categories":["Trauma","Case Report"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2022/09/11895/SNI-13-454.pdf"}