Burr-hole versus twist-drill drainage for theevacuation of chronic subdural haematoma:a comparison of clinical results

Williams, George R.; Başkaya, Mustafa K.; Menéndez, José Ángel Rivero; Polin, Richard A.; Willis, Brian J.; Nanda, Anil

doi:10.1054/jocn.2000.0926

Cited by 46 publications

(43 citation statements)

References 26 publications

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“…Four of these studies were prospective, the remaining ten were retrospective. Six compared TDC to BHC [21,26,61,74,83,98], one compared TDC to a combined group of BHC and craniotomy [36], and the other seven compared BHC to craniotomy [14,29,48,52,60,87,97]. The studies evaluated suggest that TDC may be superior to BHC in terms of infection rate [83], but worse in terms of the proportion of patients that developed signs of clinical deterioration [98].…”

Section: Relative Safety and Efficacy Of The Various Csdh Evacuation mentioning

confidence: 99%

“…Six compared TDC to BHC [21,26,61,74,83,98], one compared TDC to a combined group of BHC and craniotomy [36], and the other seven compared BHC to craniotomy [14,29,48,52,60,87,97]. The studies evaluated suggest that TDC may be superior to BHC in terms of infection rate [83], but worse in terms of the proportion of patients that developed signs of clinical deterioration [98]. Most studies also reported nonsignificant differences in recurrence rate [21,26,52,61], and no study demonstrated a significant difference in length of hospitalization [61,74], mortality [61,74,83], rate of re-operation [36], clinical course [21,60], or neurological improvement between treatment cohorts [61].…”

Section: Relative Safety and Efficacy Of The Various Csdh Evacuation mentioning

confidence: 99%

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The surgical management of chronic subdural hematoma

et al. 2011

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Chronic subdural hematoma (cSDH) is an increasingly common neurological disease process. Despite the wide prevalence of cSDH, there remains a lack of consensus regarding numerous aspects of its clinical management. We provide an overview of the epidemiology and pathophysiology of cSDH and discuss several controversial management issues, including the timing of post-operative resumption of anticoagulant medications, the effectiveness of anti-epileptic prophylaxis, protocols for mobilization following evacuation of cSDH, as well as the comparative effectiveness of the various techniques of surgical evacuation. A PubMed search was carried out through October 19, 2010 using the following keywords: "subdural hematoma", "craniotomy", "burr-hole", "management", "anticoagulation", "seizure prophylaxis", "antiplatelet", "mobilization", and "surgical evacuation", alone and in combination. Relevant articles were identified and back-referenced to yield additional papers. A meta-analysis was then performed comparing the efficacy and complications associated with the various methods of cSDH evacuation. There is general agreement that significant coagulopathy should be reversed expeditiously in patients presenting with cSDH. Although protocols for gradual resumption of anti-coagulation for prophylaxis of venous thrombosis may be derived from guidelines for other neurosurgical procedures, further prospective study is necessary to determine the optimal time to restart full-dose anti-coagulation in the setting of recently drained cSDH. There is also conflicting evidence to support seizure prophylaxis in patients with cSDH, although the existing literature supports prophylaxis in patients who are at a higher risk for seizures. The published data regarding surgical technique for cSDH supports primary twist drill craniostomy (TDC) drainage at the bedside for patients who are high-risk surgical candidates with non-septated cSDH and craniotomy as a first-line evacuation technique for cSDH with significant membranes. Larger prospective studies addressing these aspects of cSDH management are necessary to establish definitive recommendations.

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Section: Relative Safety and Efficacy Of The Various Csdh Evacuation mentioning

confidence: 99%

Section: Relative Safety and Efficacy Of The Various Csdh Evacuation mentioning

confidence: 99%

The surgical management of chronic subdural hematoma

et al. 2011

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“…We observed 14.2% of recurrences; they were mainly observed in mixt and hyperdense lesions. Recurrences seemed to be in relation with the preoperative density of the lesion and consequently with the inflammatory status of the hematoma as observed by some authors (4,5,(76)(77)(78). Overall results of the present series were in total concordance with those of large series of the literature (6,10,12,15,16,27,35,36,43,(59)(60)(61)67,79,80).…”

Section: Discussionmentioning

confidence: 64%

Open Drainage in Chronic Subdural Hematomas: A Prospective Study of 189 Cases

Bakhti

Tighilt

Djennas

2016

IrJNS

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Background & Importance: Chronic subdural hematoma (CSH) is one of the most frequent intracranial hemorrhages in adults. However, gold standard treatment of CSH is not yet defined. Since the 80's, closed drainage is a standard among techniques using drains because the open type has been incriminated in high rates of postoperative infections. However, closed drainage requires materiel which is sometimes not available or expensive in some countries. Open drainage was reintroduced in our department in the middle of the 90's because of economic crisis at this time. We have then conducted a prospective study to assess safety and efficacy of open drainage in treatment of CSH.Case Presentation: A prospective study of adult patients with CSH was conducted from January 2008 to December 2011. All patients have the same surgical procedure which included one burr-hole craniostomy, spontaneous evacuation and open drainage. The study focused on infectious complications, postoperative seizures, and recurrences. Results are compared with those of literature. In our study, 189 patients were operated with mean age of 69.2 years old. Of all, 163 patients were cured. Overall rate of complications was 15.34% with an infection rate of 1.58%, a postoperative seizure rate of 1.05% and a recurrence rate of 14.2%. Mortality rate was 5.8%. Results were in concordance with those of large series of literature. Conclusion:Data of the current study suggested that open drainage is a safe and efficient method in treatment of CSH. It is also a costefficient treatment that could be very interesting for middle-and low-income countries. Keywords AbstractBackground and Importance

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“…Since the introduction of TDC technique three decades ago (15), several studies have compared this technique with BHC in the management of CSDH, which resulted in controversial conclusions (6,8,14,17 (17). This study showed that there was no significant difference in recurrence rate, in-hospital complications, and neurological outcome at 3-month followup between the patients who received TDC or BHC treatment.…”

Section: █ Discussionmentioning

confidence: 87%

“…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).…”

mentioning

confidence: 99%

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

Wang¹,

Chen²,

Cao³

et al. 2015

Turkish Neurosurgery

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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.

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Burr-hole versus twist-drill drainage for theevacuation of chronic subdural haematoma:a comparison of clinical results

Cited by 46 publications

References 26 publications

The surgical management of chronic subdural hematoma

The surgical management of chronic subdural hematoma

Open Drainage in Chronic Subdural Hematomas: A Prospective Study of 189 Cases

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

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