Burr hole craniotomy (BHC) is a common technique employed in the treatment of chronic subdural hematoma (CSDH). However, its effectiveness and the occurrence of additional complications in relation to various irrigation techniques utilized during BHC remains unclear.

We conducted a systematic review by searching PubMed, Cochrane Library, Scopus, Ovid, and Web of Science for comparative studies that fit the eligibility criteria. All studies up to January 2023 were included, and the two groups were compared based on five primary outcomes using Review Manager Software.

Our analysis included 12 studies with a total of 1581 patients. There was no significant difference between the two techniques in terms of recurrence rate (Odds Ratio (OR)=0.98; 95% Confidence Interval (CI) 0.72-1.32, p=0.87) and mortality rate (OR=1.03, 95% CI, 0.45-2.34, p=0.95). Similarly, there was no significant difference in postoperative infection (OR=1.14, 95% CI, 0.16-8.19, p=0.90) or postoperative pneumocephalus (OR=5.91, 95% CI, 0.61-56.86, p=0.12). However, the Burr hole drainage without irrigation (BHD) technique was associated with a lower risk of postoperative hemorrhagic complication (OR=2.48, 95% CI, 1.17-5.25, p=0.02).

Our meta-analysis findings suggest that there is no significant difference between the BHD and Burr hole drainage with irrigation (BHDI) techniques in terms of recurrence, mortality rate, postoperative infection, and postoperative pneumocephalus. However, patients undergoing the BHD technique had a lower risk of postoperative hemorrhagic complication compared to those treated with BHDI. Further research and randomized controlled trials are required to understand these observations better and their applicability in clinical practice.