Randomized comparative study of burr-hole craniostomy versus twist drill craniostomy; surgical management of unilateral hemispheric chronic subdural hematomas.

Research paper by M M Gökmen, H K HK Sucu, A A Ergin, A A Gökmen, H H Bezircio Lu

Indexed on: 31 Jul '08Published on: 31 Jul '08Published in: Zentralblatt fur Neurochirurgie


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.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.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.Both surgical methods seem effective for the treatment of unilateral chronic subdural hematomas.