Twist drill craniostomy for chronic subdural hematoma [Neurosurgery Wiki]

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====== Twist drill craniostomy for chronic subdural hematoma ======


[[Craniostomy]] with [[closed system drainage]] and [[Subdural Evacuating Port System]] is an effective treatment option for [[chronic subdural hematoma]] (CSDH). 

Percutaneous bedside twist-drill drainage is a relatively safe and effective first-line management option. These findings may result in potential health cost savings and eliminate perioperative risks related to general anesthetic
((Almenawer SA, Farrokhyar F, Hong C, Alhazzani W, Manoranjan B, Yarascavitch B,
Arjmand P, Baronia B, Reddy K, Murty N, Singh S. Chronic Subdural Hematoma
Management: A Systematic Review and Meta-analysis of 34829 Patients. Ann Surg.
2014 Mar;259(3):449-57. doi: 10.1097/SLA.0000000000000255. PubMed PMID: 24096761.)).

The less invasive surgical technique of bedside percutaneous subdural tapping and spontaneous haematoma efflux after twist drill craniostomy under local anaesthesia was prospectively analysed in 118 adult patients, 99 with unilateral and 19 with bilateral CSDH.

It can be recommended in all patients as a first and minimally invasive therapy, especially in patients in a poor general condition. Patients with septation visible on preoperative CT should be excluded from this form of treatment
((Reinges MH, Hasselberg I, Rohde V, Küker W, Gilsbach JM. Prospective analysis 
of bedside percutaneous subdural tapping for the treatment of chronic subdural
haematoma in adults. J Neurol Neurosurg Psychiatry. 2000 Jul;69(1):40-7. PubMed
PMID: 10864602; PubMed Central PMCID: PMC1737018.)).

Twist-drill craniotomy for the treatment of chronic subdural hematomas and the use of the pre-coronal suture entry point
((Jung H, Shah A. Twist-drill craniotomy for the treatment of chronic subdural
hematomas and the use of the pre-coronal suture entry point. Clin Neurol
Neurosurg. 2015 Aug 14. pii: S0303-8467(15)00282-6. doi:
10.1016/j.clineuro.2015.08.007. [Epub ahead of print] PubMed PMID: 26310947.)).