New device to treat chronic subdural hematoma—hollow screw

Abstract

Different surgical approaches exist for the treatment of chronic subdural hematoma. None of these approaches is superior to the other, so a minimal-invasive device (a hollow screw) was developed. The system consists of a stable hollow screw of surgical steel with a perforated tip, a hand-drill, screwdriver with guide, and collection bag. To place the screw in the skull local anesthesia is necessary followed by stab incision and percutaneous trephination. The screw is then placed in the bone and the guide removed. After spontaneous drainage and irrigation, a closed drainage system with a collection bag is connected with the screw. First results with the new technology are promising, with a high rate of completely treated patients and a low rate of complications. Two of 86 patients had a local skin infection after implantation of the screw, and in 22 patients the procedure was repeated due to one or more cases of recurrent or residual hematoma. No neurological deterioration was caused by the screw or the surgical approach. The advantages of this new system are: quick and simple procedure, minimal invasive, excellent function, inexpensive and reusable.

Twist-drill craniostomy with hollow screws for evacuation of chronic subdural hematoma

“…6 Five studies reported performing all procedures by the bedside either in the emergency department or the neurosciences critical care unit, 2 studies reported that most of their procedures were done at the bedside (remaining in the operating room), and only 1 study reported that all procedures were performed in an operating room; the remaining study did not report procedure location. The 3 studies in which not all procedures were performed at the bedside were older studies published prior to 2010.…”

“…The majority of the complications (108 of 126) were reported by Krieg et al 9 Wound infections were rare, and the only cases of postoperative meningitis occurred in the series of Krieg et al in which intraoperative and postoperative (once daily) irrigation were routinely undertaken. Interestingly, such intracranial infections were not noted in the study by Emonds and Hassler 6 in which irrigation was also used. One of the most important complications of CSDH is recurrence requiring reoperation.…”

“…It has been argued that the closed drainage system under slight negative pressure allows satisfactory evacuation of the CSDH without the need to insert a subdural drain, thereby reducing the risks of brain laceration and bleeding from cortical vessels. 1,6 It has also been suggested that this novel technique can shorten the length of stay, leading to cost savings. 2 The aim of this systematic review is to collate the current experience with these novel hollow screw systems and evaluate their safety and efficacy in comparison with the other surgical treatment methods.…”

“…Both techniques are explained in detail in the original publications. 1,6 The technique is advantageous in that the procedure can be undertaken at the bedside under local anesthesia and is therefore feasible in patients who are not suitable for general anesthesia. It has been argued that the closed drainage system under slight negative pressure allows satisfactory evacuation of the CSDH without the need to insert a subdural drain, thereby reducing the risks of brain laceration and bleeding from cortical vessels.…”

“…This technique can be undertaken without general anesthesia at the bedside. 1,6 The hollow screw technique can be viewed as a modification of the originally described TDC technique; 18 both techniques rely on the use of a twist drill, but the hollow screw method does not require the insertion of a catheter into the subdural space.…”