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Category: Volume 06 Issue 08 August 2018
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Title: Burr Hole Versus Twist Drill Craniostomy for Chronic Subdural Hematoma: A Blinded Randomized Study

Authors: Dr Mallika Sinha, Dr Sunil Kumar Singh, Dr Chhitij Srivastava, Dr Bal Krishna Ojha, Dr Anil Chandra

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i8.164

Abstract

Objective: To compare outcomes of Burr hole craniostomy (BHC) and Twist drill craniostomy (TDC) for unilateral chronic subdural hematoma (CSDH).

Methods: A prospective blinded randomized study was conducted in King George Medical University, Lucknow, India from April 2010 to September 2011 in 110 adult patients of unilateral hemispheric CSDH and were randomly assigned into two groups of 55 patients. One group underwent BHC and the other underwent TDC. Patients were followed up at 1, 3, and 6 month. The primary outcome variable was recurrence, other variables compared were mortality, morbidity and surgical complications, duration of hospital stay and cure rates. This study was started after ethical approval from national authorities.

Results: The two groups were similar in demographic characteristics, clinical presentations and predisposing factors but, the preoperative clinical and radiological data favored burr hole craniostomy group [mean GCS at admission {13.36 vs 12.6(p= 0.032)}, mean thickness of hematoma {21.44 vs 23.27(p=0.033)}, density of hematoma (p=0.020), mean midline shift 11mm vs 10mm (p=0.071 non-significant) in twist drill and burr hole craniostomy groups respectively]. Recurrence rates were 5.4% and 1.8%(p=0.618), morbidity 16.3% and 10.9%(p=0.405), mortality 5.5% and 0%(p=0.253), mean duration of hospital stay 7.6 days and 6.36 days(p=0.074), and contralateral chronic SDH 5.5% and 3.6%(p=0.618)  respectively in twist drill and burr hole craniostomy groups, showing non-significant difference however, cure rates (GOS 5 at 1 month) was higher in burr hole group (97% vs 84%, p=0.025).

Conclusions: BHC and TDC both are equally effective procedure for treatment of chronic subdural hematoma. TDC can be an effective bed side procedure in moribund patients where patient cannot be immediately shifted to operating room for urgent decompression.

Keywords: Burr Hole craniostomy, Twist Drill craniostomy, Chronic subdural hematoma, Randomized study.

References

  1. Chen JC, Levy ML: Causes, epidemiology and risk factors of chronic subdural hematoma.Neurosurg Clin N Am 11:399, 2000
  2. Kudo H, Kuwamura K, Izawa I, Sawa H, Tamaki N: Chronic subdural hematoma in elderly people: present status on Awaji Island and epidemiological prospect. Neurol Med Chir (Tokyo) 32:207,1992
  3. Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I,Smielewski P, et al. Use of drains versus no drains after burrhole evacuation of chronic subdural haematoma: a randomized controlled trial. Lancet 374:1067-73,2009
  4. Weigel R, Schmiedek P, Krauss  JK: Outcome of contemporary surgery for chronic subdural haematoma: evidence based review.J Neurol Neurosurg Psychiatry 74 : 937,2003
  5. Gokmen M, Sucu HK, Ergin A, Gokmen A, Bezircio Lu H . Randomized Comparative Study of burr-hole craniostomy versus twist drill craniostomy ; Surgical management of unilateral hemispheric chronic subdural hematoma. Zentrabl Neurochir 69(3):129-33, Aug 2008
  6. Horn EM, Feiz-Erfan I, Bristol RE, Spetzler RF, Harrington TR: Bedside twist drill craniostomy for chronic subdural hematoma: a comparative study. Surg Neurol 65:150–153, 2006
  7. Markwalder TM. Chronic subdural haematomas a review. J Neurosurg 54:637,1981
  8. Hamilton MG, Frizzell JB, Traumer BI. Chronic subdural haematomas. The role of craniotomy re-evaluated. Neurosurgery 33:67, 1993
  9. Svein HJ, Gelety JE. On the surgical management of encapsulated subdural haematoma. A comparison of results of membranectomy and simple evacuation. J Neurosurg 21:172,1964
  10. Robinson RG. Chronic subdural haematoma, surgical management in 133 patients. J Neurosurg 61:263,1984
  1. Markwalder TM, Steinsiepe KF, Rohner M, Walter R, Markwalder H. The course of subdural haematomas after burr hole craniostomy and closed system drainage. J Neurosurg 55:390, 1981
  2. Muzii VF, Bistazzoni S, Zalaffi A, Carangelo B, Mariottini A, Palma L: Chronic subdural hematoma: comparison of two surgical techniques. Preliminary results of a prospective randomized study. J Neurosurg Sci 49:41–46, 2005
  1. Smely C, Madlinger A, Scheremet R: Chronic subdural haematoma—a comparison of two different treatment modalities.Acta Neurochir (Wien)  139:818, 1997
  2. Williams GR, Baskaya MK, Menendez J, Polin R, Willis B, Nanda A Burr-hole versus twist-drill drainage for the evacuation of chronic subdural haematoma: a comparison of clinical results. J Clin Neurosci 8:551,2001
  1. Krauss JK, Marshall LF, Weigel R :Medical and Surgical Management of Chronic Subdural Hematomas, in Youmans JR (ed):Neurological Surgery, ed 6. Philadelphia: WB Saunders, 2010, vol 1, pp. 535-543
  2. Hennig R, Kloster R: Burr hole evacuation of chronic subdural haematomas followed by continuous inflow and outflow irrigation. Acta Neurochir (Wien) 141: 171,1999 
  3. Ram Z, Hadani M, Sahar A, Spiegelmann R: Continuous irrigation-drainage of the subdural space for the treatment of chronic subdural haematoma. A prospective clinical trial. Acta Neurochir (Wien) 120:40, 1993 
  4. Nakaguchi H, Tanishima T, Yoshimasu N: Relationship between drainage catheter location and postoperative recurrence of chronic subdural hematoma after burr-hole irrigation and closed-system drainage. J Neurosurg 93:791, 2000
  1. Villagrasa J, Prat R, Diaz JF. Analysis of prognostic factors in adults with chronic subdural haematomas. Neurologia (Spanish)13:120, 1998
  2. Lega B C, Danish S F, Malhotra NR, Sonnad SS, Stein SC: Choosing the best operation for chronic subdural hematoma a decision analysis. J Neurosurg 113:615-621,2010

Corresponding Author

Dr Mallika Sinha

Assistant Professor, Neurosurgery Bhopal  Memorial  Hospital & Research Centre, Bhopal, MP, India