Prospective analysis of bedside percutaneous subdural tapping for the treatment of chronic subdural haematoma in adults

Abstract

Objectives-Although there is general agreement that surgery is the best treatment for chronic subdural haematoma (CSDH), the extent of the surgical intervention is not well defined. Methods-The less invasive surgical technique of bedside percutaneous subdural tapping and spontaneous haematoma efflux after twist drill craniostomy under local anaesthesia was prospectively analysed in 118 adult patients, 99 with unilateral and 19 with bilateral CSDH. Results-The mean number of subdural tappings was 3.2. Ninety two of the patients with unilateral CSDH were successfully treated by up to five subdural tappings, 95% of the patients with bilateral CSDH were successfully treated by up to 10 subdural tappings. The mean duration of inpatient treatment was 12 days. In 11 patients (9%) the treatment protocol had to be abandoned because of two acute subdural bleedings, two subdural empyemas, and seven cases of insuYcient haematoma eZux and no neurological improvement. The only significant predictor for failure of the described treatment protocol was septation visible on preoperative CT. Conclusions-The described therapy protocol is-apart from a purely conservative treatment-the least invasive presently available surgical technique for treating chronic subdural haematoma. Its results are comparable with other modern treatment protocols. Thus, it can be recommended in all patients as a first and minimally invasive therapy, especially in patients in a poor general condition. Patients with septation visible on preoperative CT should be excluded from this form of treatment. (J Neurol Neurosurg Psychiatry 2000;69:40-47)

Modified twist drill technique in the management of chronic sub dural hematoma.

“…The risk of pneumocephalus could be reduced by the immediate skin closure after cessation of spontaneous blood efflux in the 30° Trendelenburg position. This technique, though effective, was associated with acute subdural bleedings, intracerebral bleeding, subdural empyemas, and insufficient hematoma evacuation (12).…”

“…Another modified bed side technique by Reinges et al was also found to be effective, which could be recommended in patients with poor general condition (12). Twist drill was performed using a 3 mm hand driven drill to penetrate the skull only.…”

“…The common complications associated with this technique are inadequate drainage, brain penetration, acute epidural hematoma and catheter folding (16). These complications can be avoided by modifications of the technique (1,4,5,12,13,16). We are presenting modifications of this technique to prevent complications of TDC.…”

Critical Classification of Craniostomy for Chronic Subdural Hematoma; Safer Technique for Hematoma Aspiration

“…15,21) Twist drill craniostomy was introduced as a less invasive method for the treatment of CSDH, and is used worldwide. 13,19) The two burr-hole method is also widely used, 15,21) and was introduced to achieve sufficient irrigation, which could reduce the rate of recurrence of CSDH. 3,12) One burr-hole craniostomy with or without irrigation may be the most important surgical method and the most widely used in Japan.…”

“…7,21,23) Craniotomy is generally not performed because of the invasiveness of the procedure. Craniostomy is the main method of surgical treatment, 23) and is performed by twist drill craniostomy (diameter less than 5 mm), 6,7,13,19,23) one burr-hole craniostomy (8-15 mm), 5,7,18,20) and two burr-hole craniostomy. 15,21) Twist drill craniostomy was introduced as a less invasive method for the treatment of CSDH, and is used worldwide.…”