European Journal of Molecular & Clinical Medicine

Background: To study and assess the predisposing factors, age, sex distribution, modes of presentation, and management strategies of chronic subdural hematoma.
Materials and Methods: It was a Prospective study. The study was carried out during the Period from March 2020 to January 2022. Sample size included 30 patients. Informed consent will be taken from all the patients included in the study.
Results: A total of 30 patients were included in my study.  In this study, the majority of the patients were > 60 year of age (40%). The youngest patient was 30yrs, and the oldest was 84 years. The mean age (59.2 years).   The mean GCS was 8 in patients with LOC, 8.36±0.74 in those with altered sensorium, and 9.5±3.78 in patients with seizures. The GCS was comparatively better in patients with weakness (12.14±2.79) and headache (15). In the present study 40% of pt came with GCS 13- 15, and 36.6% came with GCS 9-12. In the present study out of 30 patients, 17 patients (56.7%) had right side involvement, 12 patients (40.0%) had left side involvement and 1 patient (3.33%) had bilateral involvement. More than 95% of patients had FTP involvement. Out of 31 scans, 74.1% of patients had a homogenous type and 22.5% had a layered type appearance on CT.
Conclusion: All patients are managed with burr hole tapping and placement of a subperiosteal drain. On further follow-up, around 2 to 3 months, SDH is completely resolved in all 29 patients and no recurrence of CSDH is noted.

Back ground: Chronic subdural hematoma (CSDH) is a common neurological condition that mainly occurs in the elderly. The minimally invasive procedure-twist drill craniostomy (TDC) is theoretically more suitable to treat CSDH than the traditional procedure-burr hole craniostomy (BHC). Compared with burr hole craniostomy (BHC), twist drill craniostomy (TDC) is getting increasingly popular because of its minimal invasiveness in evacuating chronic subdural hematoma (CSDH) under Local Anaesthesia. However, the TDC technique varies and is continually developing; moreover, no consensus yet exists regarding the optimal protocol and the efficacy and safety of TDC is still controversial.
Methods:A randomized study involving 83 patients with CSDH who underwent surgical evacuation at a single center was conducted, involving 41patients undergoing Twist Drill Craniostomy (TDC group) and 42 patients treated by Bur Hole Craniostomy (BHC group). The neurological outcome was studied to evaluate the efficacy of surgery and the radiological outcome was assessed as a supplement to the surgical efficacy. In addition, complications, recurrence, and reoperation, as well as pneumocrania, duration of operation and length of stay, were studied to evaluate the advantages of the modified TDC compared with BHC. Independent sample t tests or rank-sum tests were used to compare the outcomes between the 2 groups.
Results: There was significant improvement in both Markwalder grading scale and Glasgow coma scale in both twist drill and burr hole group within 24 hrs of intervention.The recurrence rate was 17.1% in the twist drill group and 11.9% in the burr hole group. There were 8 deaths in the twist drill group and 1 death in the Burr hole group but none were attributable to the procedures. All deaths that occurred were attributable to pre-existing co-morbidities.
Conclusions: TDC is a minimally invasive surgical technique to treat CSDH; this procedure isas effective as BHC, but safer and simpler than BHC and should be considered for patients with CSDH, especially the elderly.