Randomized Comparative Study of Burr-hole Craniostomy Versus Twist Drill Craniostomy; Surgical Management of Unilateral Hemispheric Chronic Subdural Hematomas

Abstract

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.

Zusammenfassung

Fragestellung: Trotz der Tendenz zur Verkleinerung von chirurgischen Eingriffen für chronische subdurale Hämatome, besteht noch keine Einigung über die optimale Therapie. In der Literatur gibt es bisher nur eine Veröffentlichung einer randomisierten Studie, die die twist-drill Kraniostomie mit der Bohrlochtrepanation vergleicht. Das Ziel unserer Studie ist der Vergleich der twist-drill Kraniostomie mit der Bohrlochtrepanation bei unilateralen chronischen subduralen Hämatomen bei Erwachsenen.

Patienten/Materialien und Methoden: Mit der Erlaubnis der lokalen Ethikkommission wurde die Studie prospektiv geplant und randomisiert. Zwischen November 2006 und April 2007 wurden 70 Patienten (54 männlich und 16 weiblich) mit einseitigen chronischen subduralen Hämatomen operiert. Bei 32 Patienten wandten wir die Bohrlochtrepanation an und die twist-drill Kraniostomie bei den restlichen 38 Patienten. Nach der Entlassung wurden alle Patienten im ersten, dritten und sechsten postoperativen Monat kontrolliert. Mortalität, Morbidität, chirurgische Komplikationen, die eine Re-Operation erforderlich machten, Länge der Klinikaufenthalte, Rezidive, Anzahl der Re-Operationen sowie Heilungsraten wurden verglichen.

Ergebnisse: Zwei Patienten starben und ein Pa-tient entwickelte unmittelbar postoperativ eine Parese des sechsten Hirnnerven. Wir beobachteten drei Hämatomrezidive (zwei in der Gruppe der Bohrlochtrepanation und eine in der Gruppe der twist-drill Kraniostomie) und in der Gruppe der Bohrlochtrepanationen ein chronisches subdurales Hämatom auf der Gegenseite. Klinisch und radiologisch bestand zu keinem Zeitpunkt ein signifikanter Unterschied zwischen beiden Gruppen.

Schlussfolgerung: Beide chirurgischen Methoden schienen in der Therapie von chronischen subduralen Hämatomen gleichwertig zu sein.

Key words

burr-hole craniostomy - chronic subdural hematoma - twist drill craniostomy

Schlüsselwörter

Bohrlochtrepanation - chronisches subdurales Hämatom - twist-drill kraniostomie

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