[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: 0.47). 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.

  • [Show abstract] [Hide abstract]
    ABSTRACT: To analyze the analysis of recurrence rates of single versus double burr holes in patients with subacute and chronic subdural hematomas. MATERIAL and The study was a prospective randomized controlled trial on patients with subacute and chronic subdural hematomas. Collections with membranes or septae were excluded from the study. A written consent was taken from the patient or patient party after explaining the procedure. A total of 254 patients were enrolled in the study over a period of 18-months in the Department of Neurosurgery, Sheri-Kashmir-Institute of Medical Sciences, Srinagar, Kashmir. Recurrence rates in single and double-burr-hole groups were 6.15% and 4.83% respectively, which was not statistically significant. Most of the subdural hematomas can be dealt by single burr-hole drainage.
    Turkish neurosurgery 01/2014; 24(2):246-8. · 0.53 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: population, associated medical diseases such as hemodialysis, anticoagulant, and/or antiplatelet therapy. [3,4] Although the surgical techniques are simple, recurrences remain one of the challenges in the treatment. This review is based on last 21 years search (upto May 2012) on Pubmed and Google. Presentation The presentation of CSDH could vary from no symptoms to headache, seizures, decreased memory, and confusion. Patients could have difficulty in speech, swallowing, and walking. There may be weakness or numbness of arms, legs, and face. The CSDHs are usually characterized by history of head trauma, which is usually a trivial trauma. Some cases could be secondary to defective coagulation, after lumbar puncture (LP), etc., CSDH should be suspected in a patient who presents with unusually persistent headache after spinal anesthesia or LP. CSDH should be taken into account as an important differential diagnosis in reversible dementia. The differentiation between CSDH and dementia could be difficult when it is associated with the hallucinations. [5] CSDH generally occurs in elderly although it may present in young patients. It may rarely be seen in infants. The presence of bilateral CSDH in an infant raises the suspicion
    Asian Journal of neurosurgery. 11/2014; ahead of prit.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Object In this paper the authors systematically evaluate the results of different surgical procedures for chronic subdural hematoma (CSDH). Methods The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other databases were scrutinized according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement, after which only randomized controlled trials (RCTs) and quasi-RCTs were included. At least 2 different neurosurgical procedures in the management of chronic subdural hematoma (CSDH) had to be evaluated. Included studies were assessed for the risk of bias. Recurrence rates, complications, and outcome including mortality were taken as outcome measures. Statistical heterogeneity in each meta-analysis was assessed using the T(2) (tau-squared), I(2), and chi-square tests. The DerSimonian-Laird method was used to calculate the summary estimates using the fixed-effect model in meta-analysis. Results Of the 297 studies identified, 19 RCTs were included. Of them, 7 studies evaluated the use of postoperative drainage, of which the meta-analysis showed a pooled OR of 0.36 (95% CI 0.21-0.60; p < 0.001) in favor of drainage. Four studies compared twist drill and bur hole procedures. No significant differences between the 2 methods were present, but heterogeneity was considered to be significant. Three studies directly compared the use of irrigation before drainage. A fixed-effects meta-analysis showed a pooled OR of 0.49 (95% CI 0.21-1.14; p = 0.10) in favor of irrigation. Two studies evaluated postoperative posture. The available data did not reveal a significant advantage in favor of the postoperative supine posture. Regarding positioning of the catheter used for drainage, it was shown that a frontal catheter led to a better outcome. One study compared duration of drainage, showing that 48 hours of drainage was as effective as 96 hours of drainage. Conclusions Postoperative drainage has the advantage of reducing recurrence without increasing complications. The use of a bur hole or twist drill does not seem to make any significant difference in recurrence rates or other outcome measures. It seems that irrigation may lead to a better outcome. These results may lead to more standardized procedures.
    Journal of Neurosurgery 07/2014; · 3.23 Impact Factor