Abstract

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.