Abstract
Chronic Subdural Hematoma (CSDH) is one of the most common types of intracranial hemorrhage, and the prognosis is good if treated properly. The standard treatment for CSDH is surgical evacuation. Various surgical procedures are used such as burr holes evacuation, twist-drill craniostomy, and craniotomy. Our aim is to evaluate the feasibility and safety of twist dill as a first-choice treatment in evacuation of CSDH in comorbid patients. Methods: This study is a prospective analysis of CSDH evacuation using two twist drill craniostomy holes and irrigation conducted on 21 patients with different comorbidities in Assuit University Hospital between May 2017 and May 2018. Results: The overall postoperative clinical improvement was 95.2%. The operative time was less than 10 minutes in 71.4% of the patients. 4 patients showed residual collection in the post-operative CT (19%). Pneumocephaly was detected in 2 patients (9.5%). Postoperative seizures occurred in 2 patients (9.5%), and subarachnoid hemorrhage was detected in one patient (4.7%). Conclusion: This approach is a new modification of twist drill craniostomy which can decrease the postoperative residual and recurrence rates and also still a minimally invasive and lifesaving technique in patients with different comorbidities.
Highlights
Chronic subdural hematoma (CSDH) is considered one of the most common types of intracranial hemorrhage
This study is a prospective analysis of Chronic Subdural Hematoma (CSDH) evacuation using two twist drill craniostomy holes and irrigation conducted on 21 patients with different comorbidities in Assuit University Hospital between May 2017 and May 2018
Symptoms of the studied patients varied as 76.2% of the patients were presented by disturbed conscious level (DCL), 47.6% presented by weakness on the contralateral side of the hematoma, 19% presented by fits, 14.3% suffered from headache and 14.3% presented by dysphasia (Table 1)
Summary
Chronic subdural hematoma (CSDH) is considered one of the most common types of intracranial hemorrhage. Diagnosis and appropriate surgical choice allow complete recovery in most. Despite general agreement about the indication of operative treatment, the choice of the convenient surgical procedure in CSDH is still controversial [3]. Burr hole craniotomy is considered as standard surgical treatment for CSDH still the outcome reported in the literature varies widely with a percentage of reoperation up to 37% [4]
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