Chronic subdural haematoma ? a comparison of two different treatment modalities

Abstract

Burr-hole craniotomy (BHC) and closed-system drainage undoubtedly is currently the most accepted treatment offered in chronic subdural haematoma (CSDH). Although twist-drill trephination (TDT) techniques have been available for years, now a special subdural catheter kit has been launched for treatment of CSDH. In a prospective study, 33 patients with 36 CSDH were treated with a 5-mm TDT regimen and insertion of a CORDIS subdural catheter (CORDIS Corp., Miami, USA). The results are compared with a consecutive series of 33 patients treated previously with an 11-mm BHC and closed-system drainage for 40 CSDH: Recurrence and persistence rate of CSDH treated with TDT necessitating a second intervention was 18.1%, no further surgical intervention was necessary. In BHC treated patients, 33.3% of haematomas had to be reoperated on, another 6.0% had to be re-operated on a third time. Infection rate in BHC treated patients was 18.1% as compared with a 0% infection rate in patients treated with the TDT technique. Mortality rate for the BHC method was 9.0% as compared with 6.0% in the TDT treatment regimen. Significantly better clinical results are achieved using the TDT technique with insertion of a special subdural catheter, making this procedure superior to the BHC regimen.

Chronic Subdural Hematomas Treated by Burr Hole Trepanation and a Subperiostal Drainage System

“…Surgical methods proposed in recent literature mainly include twist-drill craniostomy, burr-hole trepanation, and multiple variants of craniotomy (10,17,21,23,31,36). At present, burr-hole surgery with subdural closed-drainage system is the most commonly chosen strategy.…”

Twist drill craniostomy vs Burr hole craniostomy in chronic subdural hematoma: a randomized study

“…Similarly headache was the most common complaint in the study by Smely et al (17). Cameron (2) in his series had limb weakness in 40%, cognitive disturbances in 30% and headache in 20%.…”

“…Gokmen et al (21) have reported 3% and 7% recurrence respectively in TDC and BHC group. Smely et al (17) have reported 18% and 33% reoperation rates respectively. All these study groups have noted no significant difference similar to our study except the meta analysis by weigel et al (12).…”

“…History of trauma was obtained in 75.94% of patients in this study with no difference in the two groups. Smely et al (17) has reported 50% cases related to trauma. The two groups in other studies of Horn et al (19) and Muzii et al (20) are similar.…”

Keyhole revision after failed subdural craniostomy for chronic subdural hematoma

“…The Subdural Evacuating Port System (SEPS™) by Medtronic is one of the most frequently used examples of this idea. Twist drill craniostomy appears to have morbidity similar to that of BHD, with complications reported in 0-18% of patients with twist drill procedures [9,10,11] vs. 0-25% for BHD [12,13]. Yet the rates of recurrence are empirically higher with bedside procedures: 25.9% with SEPS vs. 14.8% with BHD in the study of Rughani et al [14]; 18% (twist drill) vs. 8% (BHD) requiring reoperation/drainage in the study of Horn et al [9]; and, similarly, 17% (twist drill) vs. 0% (BHD and craniotomy) rates of inadequate SDH drainage in the study of Safain et al [15].…”