Article

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.

2 Followers
 · 
192 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Chronic subdural hematoma is a frequently encountered entity in neurosurgery in particular in elderly patients. There in a high variance in the treatment in literature. MATERIAL and We report our experience of percutaneous evacuation of chronic subdural hematoma in 28 patients. From January 2007 to July 2009, 28 patients underwent percutaneous evacuation. 27 of the 28 patients (96.4%) became asymptomatic or improved clinically. Six weeks later, the scan showed the hematoma had completely disappeared in 18 of the cases. We did not have any postoperative infection. Treatment of chronic subdural hematoma using a percutaneous operative technique is a minimally invasive method with sufficient outcome and a therapeutic alternative to the craniotomy.
    Turkish neurosurgery 01/2011; 21(4):522-6. · 0.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Refractory chronic subdural hematoma is rare, and limited published literature exists possibly because of lack of large pool of patients with most investigators. Many therapeutic options have been reported to date. Embolization of middle meningeal artery is an interesting option for refractory chronic subdural hematoma. Multi-institutional studies with pooling of patients are necessary to generate evidence-based treatment guidelines.
    Neurosurgery Quarterly 07/2011; 21(3):189–193. DOI:10.1097/WNQ.0b013e318212633b · 0.09 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Various surgical treatments have been proposed for the treatment of chronic subdural haematoma (CSDH). Herewith, we set out to compare the efficacy of an enlarged single burr hole versus double burr hole drainage for the treatment of CSDH. We studied patients with symptomatic CSDH proven by CT scan that were treated in our institute between January 2002 and January 2009. All patients were treated by an enlarged single or double burr hole drainage. A subdural drain was placed in all cases. A total of 245 patients were included in the study. Double hole drainage was performed in 156 (63.7 %) patients (group A) and an enlarged single burr hole drainage in 89 (36.3 %) patients (group B). There were nine recurrences in group A and five in group B; however, the difference was not statistically significant. There was no significant relationship between recurrence rate and age, gender, bilateral haematoma and antiplatelet or anticoagulant therapy. There was a trend towards higher risk of recurrence for patients with residual clots on postoperative CT scan. The mean hospitalization time was 6.2 days, and there was no significant difference between the two groups. No significant difference was found between patients' outcome, as assessed by Glasgow outcome scale score, and treatment method. Enlarged single burr hole and double burr hole drainage had the same efficacy in the treatment of CSDH.
    Neurosurgical Review 08/2012; 36(1). DOI:10.1007/s10143-012-0412-3 · 1.86 Impact Factor
Show more