A prospective comparative study of twist drill craniostomy versus burr hole craniostomy in patients with chronic subdural hematoma

Abstract

ABSTRACTwhile craniotomy is used as a second-tier treatment (16). Both TDC and BHC can be performed in setting of local anesthesia, and TDC can even be performed at bedside (7). Most neurosurgeons tend to use BHC as the procedure of choice to treat patients with initial CSDH (3). With a smaller diameter of skin incision and skull opening, TDC is less invasive than BHC, which theoretically favors its use in elderly patients who usually have comorbidities. Previous studies comparing therapeutic effects of TDC and BHC concluded controversial results (6)(7)(8)17). Here, we conducted a prospective cohort █ INTRODUCTION C hronic subdural hematoma (CSDH) is a neurological disorder that predominantly affects elderly people and causes serious morbidity and mortality (1,2). Surgical treatment plays an important role in the treatment of patients with symptomatic CSDH. Twist drill craniostomy (TDC), burr hole craniostomy (BHC), and craniotomy are three commonly used procedures in current clinical practice. Among them, TDC and BHC are recognized as first-tier surgical treatment AIm: This study aims to compare clinical outcomes in patients with chronic subdural hematoma (CSDH) following twist drill craniostomy (TDC) or burr hole craniostomy (BHC). mATERIAl and mEThODS: A prospective cohort study was conducted in the patients who suffered from symptomatic CSDH and received surgical treatment in our department from Jan 2011 to Dec 2013. Each patient was followed 3 months after the surgery.RESUlTS: Thirty-eight and 45 patients received TDC and BHC treatment, respectively. There was no significant difference in age, gender, head trauma, diabetes mellitus, hypertension, antiplatelet usage, clinical manifestation, the Glasgow Coma Scale score and preoperative radiographic characteristics between the two groups. Patients in TDC had a significantly shorter operating time, but a longer draining time than those in BHC (16.9 ± 6.3 min vs. 44.4 ± 7.1 min, p< 0.001; 3.1 ± 1.0 d vs. 2.5 ± 0.9 d, p= 0.003; respectively). A smaller degree of midline shift reversal was observed in patients after TDC than those after BHC (2.6 ± 2.5 mm vs. 3.9 ± 2.8, p=0.030). Seven patients (18.4%) in TDC and 5 patients (11.1%) in BHC experienced CSDH recurrence. There was no significant difference in the recurrence rate, in-hospital complications, and neurological outcomes between the two groups.CONClUSION: This study indicates that TDC and BHC have similar clinical outcomes in the treatment of patients with CSDH. A shorter operating time, but a smaller midline shift reversal and a longer draining time may be expected in patients after TDC than after BHC.

Modified bedside twist drill craniostomy for evacuation of chronic subdural haematoma.

“…An ageing population, increasing use of anticoagulants and antiplatelet medication, and greater availability of sophisticated head imaging are some of the factors that increase CSDH occurrence [6, 23]. In the era of the minimally invasive approach to surgery, the development of simple techniques to manage CSDH seems desirable [20]. Currently the drainage of CSDH can be accomplished by SC or two craniostomy methods – BHC or TDC.…”

“…Bedside TDC is an attractive alternative to standard therapies such as BHC and SC, although rarely attempted in Eastern Europe [10]. Minimal invasiveness, shorter hospitalisation, no need for general anaesthesia or an operating room are some of the benefits of TDC [11–19]. As noted by others, TDC is associated with severe complications including acute intracranial bleeding [6].…”

“…In the early 2000s TDC was noted to have a higher rate of recurrence than BHC [1]. On the other hand, recent prospective studies supported either TDC or BHC as a primary treatment method [17, 20]. Despite the typical learning curve and the potential advantages of bedside procedures, there has been a general reluctance of the neurosurgical community to adopt TDC.…”

Complications Following Burr Hole Craniostomy and Closed-System Drainage for Subdural Lesions

“…These results are relatively lower than those of previous reports that showed seizure incidences between 2.2% and 13.6%. 11 14 18 19 22) We presumed that the use of prophylactic antiepileptic drugs in a high proportion of patients contributed the relatively low rate of seizure after BCD. Five patients (62.5%) among those with newly developed seizures after BCD had provoked seizures due to new intracranial lesions.…”

“…Despite a recurrence rate that cannot be overlooked, BCDs are widely used because they have are very simple procedures and can be performed even under local anesthesia with low complication rates. 5 6 10 22) Nevertheless, as many neurosurgeons experience and has been reported in many case reports, 11 , 14 , 18 , 19 , 22) devastating complications such as acute intracranial hematoma or surgical error occur at a frequency that cannot be ignored.…”