Objective: Chronic subdural hematoma (CSDH) is a common neurosurgical disorder that
often requires surgical evacuation. To minimize the complications associated with catheter
insertion in subdural space (SD), modified the direction of burr hole was admitted. In this
study the surgical results of using acute angle burr hole are evaluated in avoidance the
pitfalls of standard burr hole. Methods: 100 patients who underwent surgical evacuation of
125 chronic SDHs by catheter insertion in subdural (SD) space through acute angle burr hole
were included in this study. They were operated upon at King Fahd Hospital, in Al-Madina
Al-Munawarah, SA between 2003 and 2008. Data including clinical features, imaging
finding, and technique of the acute angle burr hole were used to analyze the advantages of
this simple technique. Results: The acute angle burr hole was mainly admitted to avoid the
frequent complications associated with standard burr hole as parenchymal brain injury and
kinked tube at the edge from standard burr hole. Among the patients who treated with the
acute angle burr hole, no complications were reported related to catheter-burr hole interface.
Conclusions: Acute angle burr hole is an effective, simple, and safe technique but may be not
easier than the standard one in management of chronic SDHs. By using this technique the risk
of catheter-related parenchymal injury and drainage obstruction are avoided.