====== Aesthetic Numeric Analogue scale ======

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The aesthetic [[outcome]] after [[burr hole]] [[trepanation]] for the [[evacuation]] of [[chronic subdural hematoma]]s (cSDH) is often unsatisfactory, as the bony [[skull defect]]s may cause visible [[skin]] depressions. The purpose of a study of Vasella et al. from the Department of Neurosurgery, University Hospital [[Zurich]], [[Switzerland]], was to evaluate the efficacy of [[burr hole cover]] placement to improve the aesthetic outcome.

They reviewed consecutive patients treated by burr hole trepanation for cSDH with or without placement of burr hole covers by a single surgeon between October [[2016]] and May [[2018]]. The clinical data, including [[complication]]s, were derived from the institution's prospective patient registry. The primary endpoint was the aesthetic outcome, as perceived by patients on the [[aesthetic numeric analogue scale]], assessed by means of a standardized telephone interview. Secondary endpoints were [[skin depression]] rates and wound pain, as well as [[complication]]s.

From n = 33, outcome evaluation was possible in n = 28 patients (n = 24 male; mean age of 70.4 ± 16.1 years) with uni- (n = 20) or bilateral cSDH (n = 8). A total of 14 burr hole covers were placed in 11 patients and compared to 50 burr holes that were not covered. Patient satisfaction with the aesthetic outcome was significantly better for covered burr holes (mean ANA 9.3 ± 0.74 vs. 7.9 ± 1.0; p < 0.001). Skin depressions occurred over 7% (n = 1/14) of covered and over 92% (n = 46/50) of uncovered burr holes (p < 0.001). There was no difference in wound pain (p = 0.903) between covered and uncovered sites. No surgical site infection, [[Chronic subdural hematoma recurrence]], or material failure was encountered in patients who had received a burr hole plate.

In this retrospective series, placement of [[burr hole cover]]s was associated with improved aesthetic outcome, likely due to reduction of skin depressions. A randomized controlled trial is developed to investigate whether adding burr hole covers results in superior aesthetic outcomes, without increasing the risk for complications
((Vasella F, Akeret K, Smoll NR, Germans MR, Jehli E, Bozinov O, Regli L,
Stienen MN; CORRECT SCAR study group. Improving the aesthetic outcome with burr
hole cover placement in chronic subdural hematoma evacuation-a retrospective
pilot study. Acta Neurochir (Wien). 2018 Aug 28. doi: 10.1007/s00701-018-3659-9. 
[Epub ahead of print] PubMed PMID: 30155645.
)).