Pubmed and Medline databases were searched for publications from 1970 to 2012 relating to the use of burr holes in the surgical management of MMD. The reference sections of each article were reviewed, and pertinent articles were identified.
A review of case reports and case series using burr hole surgery for MMD testifies to the progressive refinement in the decision process and key technical aspects of this procedure. Favorable clinical and angiographic results have been documented in the pediatric and adult MMD population after burr holes, used either in combination with direct or indirect revascularization techniques, or more recently alone in the setting of multiple burr holes. The superficial temporal artery and middle meningeal artery have both been found to contribute to revascularization via burr holes.
Burr hole surgery is an important and versatile tool in the armamentarium of surgeons treating children and adults with MMD, allowing tailoring of the revascularization. Further studies should help to determine factors that may help predict optimal revascularization from this surgical technique.