Burr Hole Surgery for Chronic Subdural Hematoma with Extensive Scalp Burn

Neurosurgical intervention for a patient with an extensive scalp burn is rare, but it may be associated with a high risk of surgical site infection. An 80-year-old man had a severe and extensive scalp burn. A chronic subdural hematoma (CSDH) was observed on a computed tomographic view of the head, performed for the assessment of bacteremia during treatment in the intensive care unit. To evaluate whether the CSDH might underlie the patient's prolonged fever and sepsis, we urgently evacuated the hematoma using 1 burr hole. The surgery was uneventful. We made a skin incision through the deep burn wounds covering the right temporal muscle. We removed necrotic tissue from scalp burns continuously to avoid wound complications and intracranial infection. Temporal muscle with a constant blood supply served as an effective tissue for surgical wound closure. By use of this multidisciplinary approach, the CSDH resolved completely, and surgical wound complications were avoided. •More than half of patients with fatal burns have various cerebral complications.•Skin incisions may be difficult to design for patients with a scalp burn because of local infection.•We performed burr hole surgery on a patient with a severe scalp burn to allow differential diagnosis of chronic subdural fluid collection.•Our innovations were to use the temporal muscle for wound closure and to remove the necrotic scalp using a multidisciplinary surgical approach.