Twist-Drill or Burr Hole Craniostomy for Draining Chronic Subdural Hematomas: How to Choose It for Chronic Subdural Hematoma Drainage

Abstract

ObjectiveAlthough twist-drill craniostomy (TDC) has a number of procedural advantages and an equivalent outcome compared to burr hole craniostomy (BHC) for the treatment of chronic subdural hematomas (CSDHs), the latter technique remains the preferred method. We analyzed symptomatic CSDHs in whom TDC at the pre-coronal suture entry point (PCSEP) was the primary method for hematoma drainage and BHC on the parietal was the secondary option.MethodsCSDHs in 86 consecutive patients were included. TDC at the PCSEP, which is 1 cm anterior to coronal suture at the level of the superior temporal line, was the primary operational technique when the hematoma thickness was suitable, and BHC was performed via the parietal when TDC was unreasonable or failed. The clinical feasibility and outcomes of these approaches were analyzed.ResultsOf the 86 patients, 68 (79.1%) were treated by TDC, and 18 (20.9%) by BHC. All patients showed improvements in their symptoms after hematoma drainage. Neither morbidity nor mortality was associated with either technique, and there were no differences in drainage days between the groups. Ten patients had bilateral hematomas and were treated using TDC. Two patients were not sufficiently treated by TDC and, as a result, BHC was applied. Only six hematomas (7% of 86 hematomas) exhibited insufficient thickness on the computed tomography to perform TDC.ConclusionWhen the hematoma was thick enough, a majority of the CSDHs were drained using TDC at the PCSEP as the first procedure, which was especially useful for bilateral hematomas and in elderly patients.

Twist Drill Evacuation of Chronic Subdural Hematoma in Comorbid Patients

“…Our results showed that the mean operative time (the time starts with the first surgical step and stops by its end) in our studied cases was 8.38 minutes with a mean operative room time (the time between the patient's entrance to the opera-Open Journal of Modern Neurosurgery tive theatre and his exit from it) approximately 32 minutes. Lee SJ, Hwang on 2016 in a study on twist drill evacuation of CSDH reported an operative time of 8.9 minutes which is close to our results [19].…”

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

“…Since both methods had similar effectiveness, the surgeon selected between TDC and BHC according to his or her own preference [18]. The TDC ensures the safety of the patient during the procedure and can be done in the treatment room on the ward under local anaesthesia [15]. These factors represent a huge advantage of this technique.…”

“…In Poland almost all patients are offered either BHC or SC. Choosing the best operation for CSDH concerned authors in the past [15, 28]. Every CSDH case differs from another, whereas systematic reviews and meta-analyses lack the individual approach to CSDH.…”

“…Given that the mean age of presentation for a CSDH is in the sixth decade of life, which is directly linked to comorbidities, patients with diabetes or ischaemic heart disease or taking oral anticoagulants are at significant risk of perioperative and postoperative complications [7, 32]. In that group, a less invasive procedure such as TDC seems to be especially advantageous [15, 20]. Our findings do not support the above statement, as the decision upon selection between TDC, BHC or SC has not been based on clinical characteristics but on radiological findings.…”

“…Nevertheless, a meta-analysis demonstrated that irrigation may lead to better outcomes [27]. Another disadvantage of TDC is certainly the patient’s discomfort during the procedure, although that topic was not alluded whereas a single author disagreed with that opinion [15].…”