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


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.

34 Reads
  • [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.
    No preview · Article · Jul 2011 · Neurosurgery Quarterly
  • 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.
    Full-text · Article · Oct 2011 · Turkish neurosurgery
  • [Show abstract] [Hide abstract]
    ABSTRACT: Chronic subdural hematoma (CSDH) has been treated by a variety of surgical approaches like twist drill craniostomy (TDC), burr hole craniostomy (BHC), craniotomy, etc. There are large variations in cure rates and recurrence rates among the surgical options in literature and like all surgical techniques, there is a paucity of well-designed trials to sort out the issue. It is an accepted fact of surgery that the least invasive approach will often be the best approach. We set out with the hypothesis that TDC is as safe and as effective as BHC for CSDH treatment. A prospective randomized controlled trial for 100 patients was done to compare the results of TDC and BHC (both with drain) in patients of unilateral CSDH. Recurrence rate was the primary outcome variable evaluated. A strict clinic-radiological criteria was used to avoid ambiguity in the study. Forty-eight patients underwent TDC and 52 patients underwent BHC. Mortality was 2% (patients in low GCS), and 2% unexpected mortality occurred (unrelated causes). Complication rate was 14% overall and was similar in both groups. Overall outcome (primary and secondary) was comparable across both groups with no significant difference. Cost, invasiveness and duration of surgery was significantly less in the TDC group. The cure rate, recurrence rate, mortality and morbidity of TDC with drain is significantly similar to that of BHC with drain for treatment of defined patients of unilateral sub-acute and chronic subdural hematoma. The cost, duration and invasiveness of TDC surgery is significantly less than that for BHC surgery.
    No preview · Article · Dec 2011
Show more