Twist drill craniostomy with closed drainage for chronic subdural haematoma in the elderly: an effective method.
OBJECTIVE
Chronic subdural haematoma is a disease of the elderly and surgery in these patients carries a much higher risk. The common surgical procedures for chronic subdural haematoma include twist drill craniostomy, burr hole evacuation or craniotomy. The aim of this study was to analyse the results of twist drill craniostomy with drainage in elderly patients with chronic subdural haematoma.


METHODS
Forty-two elderly patients (>65 years) with radiologically proven chronic subdural haematoma were analysed. All the patients underwent twist drill craniostomy and continuous drainage of the haematoma under local anaesthesia and total intravenous anaesthesia (TIVA).


RESULTS
There were 24 males and 18 females. Headache and cognitive decline was seen in 50% and weakness of limbs in 60% of patients. CT scan was done in all cases. All patients underwent twist drill 2-3 cm in front of the parietal eminence under local anaesthesia. The drain was left for 24-72 h depending on the drainage. At 1 week, 88% of patients had a good outcome.


CONCLUSIONS
Twist drill craniostomy with drainage under local anaesthesia is a safe and effective procedure for chronic subdural haematoma in the elderly and could be used as the first and only option in these people.
Department of Neurosciences, Dr. SMCSI Medical College, Karakonam 695504, India. r_ramnarayan@yahoo.com
R
R
Ramnarayan
B
B
Arulmurugan
Paul M
PM
Wilson
Rani
R
Nayar
D000368:Aged; D000369:Aged, 80 and over; D000771:Anesthesia, Intravenous; D000772:Anesthesia, Local; D003399:Craniotomy / Q000295:instrumentation* / Q000379:methods*; D004322:Drainage; D005260:Female; D020200:Hematoma, Subdural, Chronic / Q000000981:diagnostic imaging / Q000523:psychology / Q000601:surgery*; D006801:Humans; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D012886:Skull / Q000000981:diagnostic imaging; D013525:Surgical Instruments; D016896:Treatment Outcome