Chronic subdural haematoma: a comparative study between twist-drill craniostomy and burr-hole technique

ABSTRACT

Surgical treatment of chronic subdural haematoma [CSH] is well established but the optimal technique to be used is still controversial. We performed a non-randomised retrospective comparative study on 154 patients with 199 CSHs [45 being bilateral] operated at the Hotel-Dieu de France Hospital between January 1995 and January 2004. The mean age was 61 years with male to female ratio of 125 male / 29 female. The two categories of patients treated with trepanation and twist-drill were comparable regarding age, sex, bilateral, clinical score of Markwalder and computed tomography scan results. The surgical technique used was trepanation in 109 and twist-drill in 45. The twist-drill technique is that described by Shulman with some modifications. Clinical evaluation was performed at 1 and 6 months after surgery. The postoperative complications, mortality and recurrence rate were respectively 10, 0.91 and 13.75% in the trepanation group and 2.2, 0.5 and 2.2% in the twistdrill group. Hospitalisation time was significantly lower in the twist-drill group [40% of the patients were discharged on the third day compared to 10% in the trepanation group]. We believe that the twist-drill technique for evacuation of CSH is less invasive, can be performed under local anaesthesia and allows for slow decompression of the brain with less complications, decreased possibility of recurrence and shorter hospital stay. More prospective randomised studies are needed to confirm this treatment of choice