Randomized comparative study of burr-hole craniostomy versus twist drill craniostomy; surgical management of unilateral hemispheric chronic subdural hematomas.

OBJECTIVE: Although there is a tendency to minimize the surgical procedures for chronic subdural hematomas, there is no agreement on the optimal treatment. In the literature there is only one published result of a randomized study comparing twist drill craniostomy with burr-hole craniostomy. We aimed to compare twist drill craniostomy with burr-hole craniostomy for the treatment of unilateral hemispheric chronic subdural hematomas in adults. MATERIAL AND METHODS: The study was planned as a prospective, randomized, controlled investigation. Between November 2002 and April 2006, 70 patients (54 male and 16 female) with unilateral hemispheric chronic subdural hematomas were operated. 32 patients underwent burr-hole craniostomy and 38 patients were treated by twist drill craniostomy. After discharge, the patients were followed up at 1, 3 and 6 months after operation. Mortality, morbidity, surgical complications requiring reoperation, duration of hospitalization, recurrence, total number of reoperations, and cure rates were compared. RESULTS: Two patients died and one patient developed 6th nerve paresis in the inpatient period. There were three recurrences (two in the burr-hole craniostomy group, one in the twist drill craniostomy group) and in one patient from the burr-hole craniostomy group a chronic subdural hematoma developed on the contralateral side postoperatively. There was no significant difference clinically and radiologically between the two groups at any time period. CONCLUSION: Both surgical methods seem effective for the treatment of unilateral chronic subdural hematomas.

Percutaneous anterior odontoid screw fixation.

OBJECTIVE: A technical description of a novel percutaneous technique of anterior odontoid screw fixation is given and the clinical and radiological results of this technique in 5 patients are described. METHOD: The percutaneous anterior odontoid screw fixation technique was described as a cadaveric study in 1999. To the best of our knowledge, no patient series operated on by this technique has so far been presented in the English literature. We have percutaneously operated on 5 patients with unstable odontoid fractures between February 2004 and July 2006. RESULTS: There have not been any complications in our patients. The first four patients showed radiological evidence of fusion in their latest control. CONCLUSIONS: Percutaneous anterior odontoid screw fixation is a minimally invasive and feasible surgical procedure.

Is there a way to avoid surgical complications of twist drill craniostomy for evacuation of a chronic subdural hematoma?

BACKGROUND: Although twist drill craniostomy for evacuation of a chronic subdural hematoma is a rapid and minimally invasive procedure, it carries the risk of complications because it is a 'blind' technique. Our aim was to analyse the complications in a series of patients treated by this technique in order to identify methods of avoidance by modifications in the surgical technique. METHOD: Thirty-nine patients with a chronic subdural hematoma underwent twist drill craniostomy between November 2002 and December 2005 in our clinic. When a surgical complication happened we modified our surgical technique to see if this avoided it in future patients. FINDINGS: Surgical complications happened in 7 patients (17.9%) including inadequate drainage, brain penetration, acute epidural hematoma and catheter folding. After preventive modifications these complications did not recur. CONCLUSIONS: Modifications in the technique of twist drill craniostomy are described in this paper which may minimise the occurrence of surgical complications.

Contralateral development of chronic subdural hematoma after evacuation of chronic subdural hematoma. A case report.

Contralateral acute complications such as acute epi/subdural hematomas can be encountered after evacuation of a chronic subdural hematoma, though they are rare. We found only one case of chronic subdural hematoma following the surgery for contralateral chronic subdural hematoma, have been published in English language literature. A 73-year-old male admitted to our hospital with a right-sided subdural hematoma. The subdural hematoma was evacuated through a burr-hole. A left-sided subdural higroma appeared after operation and turned into classical subdural hematoma in the course of time. After evacuation of contralateral chronic subdural hematoma, the patient recovered completely. All stages of the development of contralateral chronic subdural hematomas were shown by serial computed tomograms. It was suggested that traumatic chronic subdural hematomas develop from mostly subdural higromas. If contralateral subdural higroma is seen after surgical evacuation of a chronic subdural hematoma, the possibility of development of contralateral chronic subdural hematoma must be kept on mind.

Depressed fractures over cranial venous sinus.

Seventeen patients with depressed fractures over cranial venous sinus who had undergone operations between 1993 and 1998 were reviewed retrospectively. There were 15 male and two female patients. Their ages ranged from 7 to 48 years. The most frequent causes of trauma were motor vehicle accident (in eight cases) followed by assault (in six cases). In the majority of cases, depressed fractures were localized over the superior sagittal sinus, and half of them were over the medial third of the sinus. In 11 cases, massive blood loss occurred intraoperatively that could be controlled by digital pressure with gelfoam or with a free muscle flap. Postoperative infection developed in one case and was treated successfully with antibiotic medication alone. Two patients died due to associated intracerebral lesions. The remaining 15 patients returned to daily living activity in the follow-up period.

Middle latency auditory evoked potentials in patients with parkinsonism.

The aim of this study was to assess the middle latency auditory evoked potential (MLAEP) findings in idiopathic Parkinson's disease (IPD) and in patients who are regarded as having atypical parkinsonian disorders (AP) and to determine whether MLAEPs could contribute to the differential diagnosis of IPD and AP.MLAEPs were evaluated in 19 control subjects and in a total of 35 patients with parkinsonism, of which 27 had IPD and 8 had AP. Among IPD patients, P1 was absent in 1 nondemented patient with young-onset Parkinson's disease (YOPD) (5%) and in 2 of 7 demented (28.5%) IPD patients. In the AP group, 3 of the 7 (42.8%) nondemented patients and the one patient with dementia showed the absence of P1. The absence of P1 was found to be significantly higher in AP patients than IPD patients (p=0.0335).In conclusion, MLAEPs were found to be normal in nondemented IPD patients with only a few exceptions. The absence of P1 in nondemented patients with parkinsonian symptoms may bring the diagnosis of IPD into question. The absence of P1 could be detected in AP patients at least as often as in demented IPD patients. Thus, the measurement of MLAEPs may be a clinically useful adjunct to the clinical examination of patients with parkinsonism.