gms | German Medical Science

Objective: Chronic subdural hematoma (CSDH) is considered to be one of the most common diseases in neurosurgical practice. Incidence is increasing with a growing elderly population. In principle, every symptomatic hematoma should be treated operatively. The best operative method remains controversial. We will demonstrate the efficacy and feasibility of Twist drill craniostomy (TDC) concerning the recurrence rate and complications from a center with nearly 20 years of experience in routine TDC for CSDH

Methods: All patients operated by TDC between December 2016 to December 2019 were enrolled and analysed retrospectively. Clinical course, outcome and complications were studied. Clinical examination included the Markwalder score (MGS) at the admission and discharge. Primary outcomes were assessed as the neurological and radiological results at discharge. Treatment success was defined as sufficient treatment of CSDH via TDC with improvement the clinical and radiological findings. Any readmission with necessity for recurrent operative treatment, or use of craniotomy as a secondary treatment following the initial admission were considered as treatment failures

Results: A total of 300 patients were included. Male to female ratio was 2.6:1. The age ranged from 32 to 100 years (median 79). The main initial symptom of patients was headache in 44,5%, followed by neurological deficits in 35%. Hematoma thickness on admission ranged from 5 mm to 40 mm (median of 21). Overall 58% of the patients presented with neurological deficits on admission. The statistical analysis showed a significant improvement of the Markwalder grading score (p=0.001) and the hematoma thickness (p=0.001) at discharge. In total 32,3 % treatment failures were observed, out of which 14,3% of the patients showed no satisfactory initial treatment by TDC and were treated by BHT during the same hospital stay. Remaining 18% of primary treatment failures were readmitted with recurrence. These occurred independent of age (p= 0.193), initial hematoma thickness (p= 0.182) or use of anticoagulants (p= 0.644). The overall complication rate was 7%

Conclusion: TDC is an effective bedside method of treating CSDH first-line with significant improvement of neurological and radiological outcome. Despite a significant number of treatment failures (cross-over to second-line operative treatments and true recurrencies) the overall complication rate was low. The effectiveness does not appear to be determined by age, extent of CSDH or use of anticoagulants