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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Twist drill procedure for chronic subdural hematoma evacuation- an analysis of predictors for treatment success

Meeting Abstract

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  • Fidaa Jablawi - Universitätsklinikum Aachen (AöR) , Klinik für Diagnostische und Interventionelle Neuroradiologie, Aachen, Deutschland
  • Huda Kweider - Aachen, Deutschland
  • Omid Nikoubashman - Uniklinik Aachen, Klinik für Diagnostische und Interventionelle Neuroradiologie, Aachen, Deutschland
  • Hans Rainer Clusmann - Universitätsklinikum der RWTH Aachen, Neurochirurgische Klinik, Aachen, Deutschland
  • Gerrit Schubert - Universitätsklinikum der RWTH Aachen, Neurochirurgische Klinik, Aachen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMi.17.07

doi: 10.3205/17dgnc482, urn:nbn:de:0183-17dgnc4829

Published: June 9, 2017

© 2017 Jablawi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Twist drill craniostomy (TDC) is a “minimally invasive” and cost-effective technique to treat chronic subdural hematomas (CSDH). Predictors for treatment sufficiency such as imaging characteristics, hematoma volume, and drainage volume - are not established so and are purpose of this analysis.

Methods: We retrospectively evaluated all data of CSDH patients undergoing TDC in our institution between January 2010 and December 2013. We analyzed imaging characteristics (extension and composition), volumetrically calculated pre- and postoperative hematoma volume, measured drainage volume, and clinical course. As volumetric analysis, we evaluated the hematoma volume on the available pre- and post-treatment CT via Osirix 7.0 (Advanced open-source PACS Workstation, ©Pixmeo SARL, Berne, Switzerland). For volumetric assessment, we transferred the respective DICOM data of all included patients into the Osirix Workstation and identified the hematoma on each axial image. Finally, a 3D image of individual hematoma was calculated to define its extension and volume. Treatment was defined as sufficient if definitive treatment was achieved via a single TDC (TDC-1) and insufficient if more than one TDC was needed (TDC-X). The need for open surgical evacuation was defined as treatment failure.

Results: Data of 233 patients undergoing 387 TDCs were available for our study. Treatment was sufficient in 124 (32%), insufficient in 136 (35%), and failed in 127 (33%) procedures. Using the median-split-method, sufficient treatment was achieved more frequently in smaller hematomas (p<0.05). Treatment sufficiency was neither correlated with hematoma image characteristics (presence of membranes: p=0.11, extent of chronification: p=0.55), nor with the respective drainage volume (p=0.95). Residual hematoma volume was consistently higher than expected by drainage calculation (p<0.05).

Conclusion: TDC is an effective treatment option for CSDH. Sufficient treatment was more common in smaller hematomas with an associated smaller residual hematoma. Failure of brain re-expansion after TDC may increase the treatment failure rates. In these cases, an open surgical evacuation might accelerate treatment and clinical recovery.