Comparison of manual hand drill versus an electric dual-motor drill for bedside craniotomy

Abstract

Rapid decompression of elevated intracranial pressure is essential to reducing morbidity and mortality rates associated with subdural and epidural hematomas. The increase of speed and accuracy will improve patient outcomes by reducing red blood cell breakdown and avoiding infarction and vasospasm of cerebral tissue. A dual-motor drill was created to mitigate overpenetration to reduce iatrogenic injury and improve accuracy and efficiency of bone drilling. The dual-motor drill simultaneously controls revolutions per minute (600 RPM) and insertion rate with a real time display monitoring depth and torque. The purpose of this study was to compare the drilling accuracy and technical malfunctions associated with the use of a manual drill to an experimental battery powered drill. Our hypothesis was that a dual-motor drill would be more accurate, require less time, and have fewer technical malfunctions than a manual drill. A 2.7 mm drill bit was used to burr ten pilot holes in the temporal bone, spaced one centimeter apart. The depth of these pilot holes served as a control and each burr hole was measured using C-arm fluoroscopy and a digital caliper. Drilling accuracy was calculated by the measured plunge (mm) of the drill bit past the inner cortex of the skull. The dual-motor drill showed significantly less depth measurement error, plunge depth, improved burr hole accuracy, reduced overpenetration, and decreased intraoperative time for drilling in cadaveric bone.