[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: 0.32). 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.

  • 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; · 3.15 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; · 1.97 Impact Factor