Bedside twist drill craniostomy for chronic subdural hematoma: a comparative study.

BACKGROUND: Although the bedside twist drill craniostomy is used to treat chronic subdural hematomas, the efficacy of this technique has not been compared with that of standard treatments (operative bur hole or craniotomy).

METHODS: Twist drill craniostomy was compared with operative bur hole or craniotomy in a prospective nonrandomized trial. The inclusion criteria were computed tomographic evidence of chronic subdural hematoma (isodense or hypodense compared with brain) and symptoms indicating the need for drainage. Selection of the procedure depended on the on-call surgeon's preference. Clinical success of the procedure, recurrence, length of hospitalization, complications, and neurologic outcome were compared.

RESULTS: Between August 2001 and October 2002, 79 consecutive patients with 91 chronic subdural hematomas were treated (67 unilateral and 12 bilateral) at our institution. Fifty-five patients were treated with twist drill craniostomy and 24 with bur hole or craniotomy. There were no differences in the mean age of presentation, thickness of hematoma, length of hospitalization, reoperation rate, mortality rates, or ability to be discharged to home between the 2 groups. There was no difference in the neurologic outcomes in the 57 of the 79 patients available for follow-up.

CONCLUSIONS: Twist drill craniostomy performed at the bedside is just as effective in treating chronic subdural hematomas as bur holes or craniotomy in the operating room. This procedure can most often be the first line of treatment in patients with symptomatic chronic subdural hematomas.