Evacuation of chronic subdural hematomas with the Twist-Drill technique: Results of a randomized prospective study comparing 48-h and 96-h drainage duration

Service de neurochirurgie A, hôpital neurologique Pierre-Wertheimer, université Claude-Bernard, 59, boulevard Pinel, 69003 Lyon, France.
Neurochirurgie (Impact Factor: 0.41). 02/2010; 56(1):23-7. DOI: 10.1016/j.neuchi.2009.11.007
Source: PubMed

ABSTRACT Technical modalities for the evacuation of chronic subdural hematomas are still controversial. The Twist-Drill technique with closed-system drainage is becoming more widely used, but the influence of drainage duration on outcome has not been studied yet and therefore is still being debated.
A prospective randomized study was conducted, comparing the results between two drainage durations. Forty-eight hours (Group I; n=35 patients) and 96 h (Group II; n=30 patients).
The two groups had almost identical characteristics due to randomization. The mean volume of liquid drained was 120 ml in the first group and 285 ml in the second, a statistically significant difference. The rate of incomplete evacuation versus the rate of recurrence did not show any significant difference between Group I (5.7 % and 11.4 %, respectively) and Group II (3.3 % and 10 %, respectively). The rate of postoperative complications was 10.7 % in Group I but 26.9 % in Group II, with a respective 3.8 % and 11.4 % mortality rate, proving a statistically significant difference. Clinical improvement observed at discharge was 85.7 % and 84.6 % in Group I and Group II, respectively.
With comparable recurrence and improvement rates, our study demonstrates that it is much more advantageous to remove the catheter at 48 h than leave it in for a longer duration. Not only is bed rest reduced, but the rate of morbidities is also significantly decreased.

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