title: Minimally invasive decompression of chronic subdural haematomas using hollow screws: efficacy and safety in a consecutive series of 320 cases.
abstract: BACKGROUND
  Chronic subdural haematoma (cSDH) is a frequent pathology in neurosurgery. Surgical treatment varies widely and is often characterised by repeated decompression. Therapeutic efficacy was evaluated by clinical symptom relief and haematoma reduction on preoperative and postoperative CT scans.
  
  
  METHODS
  We investigated a consecutive series of 320 cases of cSDH between 2006 and 2010. In this series, the first- and second-line treatments were performed via hollow-screw placement under local anaesthesia, whereas enlarged burr holes under general anaesthesia were used as third-line treatment.
  
  
  RESULTS
  In general, 63.3% of cases were sufficiently treated by a single operation, while 16.2% needed a second procedure with hollow screws. Only 20.5% needed open surgery by an enlarged burr hole with membranectomy under general anaesthesia. After the first operation, initial symptoms improved in 80.3% of cases, remained unchanged in 15.5% and worsened in 4.2% of cases. Mean age was 74.6 ± 12.1 years, with only one case of severe surgery-related complication.
  
  
  CONCLUSIONS
  Initial placement of hollow screws under local anaesthesia is a safe and sufficient treatment in most cases, and should be favoured as first-line treatment in patients with cSDH, since these patients are often of older age and present with distinct comorbidity.
authors.affiliation: Department of Neurosurgery, Technische Universität München, Munich, Germany. Sandro.Krieg@lrz.tum.de
authors.forename: Sandro M
authors.initials: SM
authors.lastname: Krieg
authors.forename: Fanny
authors.initials: F
authors.lastname: Aldinger
authors.forename: Michael
authors.initials: M
authors.lastname: Stoffel
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meyer
authors.forename: Juergen
authors.initials: J
authors.lastname: Kreutzer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws / Q000009:adverse effects / Q000592:standards*; D019299:Decompression, Surgical / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D020200:Hematoma, Subdural, Chronic / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011859:Radiography