Twist drill procedure for chronic subdural hematoma evacuation - an analysis of predictors for treatment success.

Twist drill procedure for chronic subdural hematoma evacuation - an analysis of predictors for treatment success.

World Neurosurg. 2017 Jan 18;:

Authors: Jablawi F, Kweider H, Nikoubashman O, Clusmann H, Schubert GA

Abstract
BACKGROUND: Twist drill craniostomy (TDC) is a "minimally invasive" and cost-effective technique to treat chronic subdural hematomas (CSDH). Predictors for treatment success such as imaging characteristics, hematoma volume, and drainage volume - are not established, thus they are purpose of this analysis.
MATERIAL AND METHODS: We retrospectively evaluated all data of CSDH patients undergoing TDC in our institution between January 2010 and December 2013. We analyzed imaging characteristics (extension and composition), volumetrically calculated pre- and postoperative hematoma volumes, measured drainage volume, and clinical course. Primary treatment success was defined as sufficient if definitive treatment was achieved via a single TDC (TDC-1) and insufficient if more than one TDC was needed. The need for open surgical evacuation was defined as treatment failure.
RESULTS: Data of 233 patients undergoing 387 TDCs were available for our study. 67% of TDCs treated CSDHs effectively, whereas the remainder required further open surgical evacuation. Using the median-split-method, sufficient treatment was achieved more frequently in smaller hematomas (p<0.05). Treatment effectiveness was neither correlated with hematoma image characteristics (presence of membranes: p=0.11, extent of chronification: p=0.55), nor with the respective drainage volume (p=0.95). Residual hematoma volume was consistently higher than expected by drainage calculation (p<0.05).
CONCLUSION: TDC is an effective treatment option for CSDH. Sufficient treatment with single TDC was more common in smaller hematomas with an associated smaller residual hematoma. Failure of brain re-expansion after TDC may increase the treatment failure rates. In these cases, an open surgical evacuation might accelerate treatment and clinical recovery.

PMID: 28109862 [PubMed - as supplied by publisher]

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