An improved electronic twist-drill craniostomy procedure with post-operative urokinase instillation in treating chronic subdural hematoma

Lu, Jing; Shen, Dayong; Hu, Fangjin; Zhou, Jianjun; Lan, Folin; Guo, Dongbing; Liu, Tianqing

doi:10.1016/j.clineuro.2015.05.037

Cited by 23 publications

(12 citation statements)

References 25 publications

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“…This entry point, which is known as the pre-coronal suture entry point (PCSEP), allows for safe trephination due to prominent skull landmarks as well as the preoperative estimation of hematoma thickness using a brain computed tomography (CT) scan. The safety and technical usefulness of TDC at PCSEP have been confirmed in the literature 813). Thus, the aim of the present study was to determine the surgical experiences and patient outcomes of prospectively collected data for consecutive patients who were treated by the surgeon who originally developed the PCSEP approach.…”

Section: Introductionmentioning

confidence: 79%

“…Third, the PCSEP is close to the coronal suture, which enhances the adhesion of the dura to the skull and results in decreased risks of dural detachment and postoperative epidural hematoma. Finally, the shorter procedure time for TDC, with a mean operation duration of only 8.9 minutes,13) may obviate the need for monitored or general anesthesia, especially in confused or elderly patients. Additionally, even though a patient may be bald in the frontal region, TDC may not be contraindicated because it involves a stab incision and not a bony depression.…”

Section: Discussionmentioning

confidence: 99%

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Twist-Drill or Burr Hole Craniostomy for Draining Chronic Subdural Hematomas: How to Choose It for Chronic Subdural Hematoma Drainage

Lee

Hwang

2016

Korean J Neurotrauma

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ObjectiveAlthough twist-drill craniostomy (TDC) has a number of procedural advantages and an equivalent outcome compared to burr hole craniostomy (BHC) for the treatment of chronic subdural hematomas (CSDHs), the latter technique remains the preferred method. We analyzed symptomatic CSDHs in whom TDC at the pre-coronal suture entry point (PCSEP) was the primary method for hematoma drainage and BHC on the parietal was the secondary option.MethodsCSDHs in 86 consecutive patients were included. TDC at the PCSEP, which is 1 cm anterior to coronal suture at the level of the superior temporal line, was the primary operational technique when the hematoma thickness was suitable, and BHC was performed via the parietal when TDC was unreasonable or failed. The clinical feasibility and outcomes of these approaches were analyzed.ResultsOf the 86 patients, 68 (79.1%) were treated by TDC, and 18 (20.9%) by BHC. All patients showed improvements in their symptoms after hematoma drainage. Neither morbidity nor mortality was associated with either technique, and there were no differences in drainage days between the groups. Ten patients had bilateral hematomas and were treated using TDC. Two patients were not sufficiently treated by TDC and, as a result, BHC was applied. Only six hematomas (7% of 86 hematomas) exhibited insufficient thickness on the computed tomography to perform TDC.ConclusionWhen the hematoma was thick enough, a majority of the CSDHs were drained using TDC at the PCSEP as the first procedure, which was especially useful for bilateral hematomas and in elderly patients.

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Section: Introductionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Twist-Drill or Burr Hole Craniostomy for Draining Chronic Subdural Hematomas: How to Choose It for Chronic Subdural Hematoma Drainage

Lee

Hwang

2016

Korean J Neurotrauma

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“…[18] TDC, on the other hand, takes much less time and can be performed under local anesthesia. [19] It is procedure of choice in high-risk surgical candidates in non-septated CSDH. [20] According to some studies, results of TDC are equivalent to burr-hole craniostomy in terms of recurrence rates, morbidity, and mortality.…”

Section: Discussionmentioning

confidence: 99%

Single Parietal Burr-hole Craniostomy with Irrigation and Drainage for Unilateral Chronic Subdural Hematoma in Young Adults <40 Years: A Rationale behind the Procedure

Chandran¹,

Nagar²,

Sharmad³

et al. 2017

Journal of Neurosciences in Rural Practice

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Background:Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. It is mostly a disease of elderly population with very little data about the young patients. There is also the debate regarding treatment strategies. We decided to determine the overall efficacy of the single burr-hole craniostomy (SBHC) for unilateral CSDH in young adults <40 years.Subjects and Methods:We performed a retrospective study of young patients undergoing SBHC for unilateral CSDH between January 2013 and June 2016 at our institution. Medical records were assessed based on patient characteristics in the form of sex of the patient, etiology, presenting symptoms, comorbidities, and signs including Glasgow Coma Scale, computed tomography (CT) brain findings (site and thickness of SDH with midline shift), and intraoperative presence of chronic/subacute component.Results:Mean age of the patient was 33.69 years (range 18–40 years), mean thickness of SDH was 15.47 mm, and mean midline shift was 11.26 mm. 61.54% patients were male, trauma being the most common etiology (92.31%) with most common presenting complaint being headache (90.38% patients). 69.23% patients presented within 1 day of onset of symptoms. On CT scan, most of the patients were having SDH thickness between 11 and 20 mm (67.31%) with midline shift of 6–10 mm (53.85%). Right-sided SDH was present in 53.85%. Intraoperatively, 63.46% patients had subacute SDH whereas 34.61% had chronic component. There were total 2 recurrences (3.85%).Conclusions:Young adults who present with unilateral CSDH usually have a history of trauma. They have shorter duration of symptoms and present mainly with the features of raised intracranial pressure such as headache and vomiting. SBHC with irrigation and drainage has excellent result for unilateral CSDH in young adults compared to other methods of drainage and should be considered treatment of choice unless contraindicated.

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“…Lu et al injected 100,000 IU UK into the subdual cavity to treat a chronic subdural hematoma. 18 In this study, due to the large hematoma volume observed in our patients, we selected 30,000 IU UK to treat the epidural hematomas. We applied UK in a syringe through puncturing a closed suction drain and observed that all patients had successful drainage of the hematoma without further complications or side effects attributed to UK therapy.…”

Section: Discussionmentioning

confidence: 99%

Fibrinolytic Therapy Improves Outcomes in Patients with Epidural Hematomas Following Cranioplasty: A Pilot Study

Peng

Cao

et al. 2017

J Neurol Surg A Cent Eur Neurosurg

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An improved electronic twist-drill craniostomy procedure with post-operative urokinase instillation in treating chronic subdural hematoma

Cited by 23 publications

References 25 publications

Twist-Drill or Burr Hole Craniostomy for Draining Chronic Subdural Hematomas: How to Choose It for Chronic Subdural Hematoma Drainage

Twist-Drill or Burr Hole Craniostomy for Draining Chronic Subdural Hematomas: How to Choose It for Chronic Subdural Hematoma Drainage

Single Parietal Burr-hole Craniostomy with Irrigation and Drainage for Unilateral Chronic Subdural Hematoma in Young Adults <40 Years: A Rationale behind the Procedure

Fibrinolytic Therapy Improves Outcomes in Patients with Epidural Hematomas Following Cranioplasty: A Pilot Study

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