title: Indications and surgical results of twist-drill craniostomy at the pre-coronal point for symptomatic chronic subdural hematoma patients.
abstract: OBJECTIVE
  Twist-drill craniostomy (TDC) with closed-system drainage and burr-hole drainage (BHD) with a closed system are effective treatment options for chronic subdural hematoma (CSDH). The aim of this study was to analyze clinical data and surgical results from symptomatic CSDH patients who underwent TDC with closed-system drainage at the pre-coronal point (PCP).
  
  
  METHODS
  We analyzed data for 134 symptomatic CSDH patients who underwent TDC at the PCP with closed-system drainage. We defined the PCP for TDC to be 1 cm anterior to the coronal suture at the level of superior temporal line. TDC at the PCP with closed-system drainage was selected in patients with CSDH that extended beyond the coronal suture, confirmed by preoperative CT scans. Medical records, radiological findings, and clinical performance were reviewed retrospectively.
  
  
  RESULTS
  Of the 134 CSDH patients, 114 (85.1%) showed improved clinical performance and imaging findings after surgery. Catheter failures were seen in two cases (1.4%); the catheters were inserted in the epidural space. Recurrent cases were seen in eight patients (5.6%), and they were improved with a second BHD with a closed-system operation.
  
  
  CONCLUSIONS
  TDC at the PCP with closed-system drainage is safe and effective for patients with symptomatic CSDH whose hematomas extend beyond the coronal suture.
authors.affiliation: Department of Neurosurgery, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea.
authors.forename: Jin-Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Bum-Tae
authors.initials: BT
authors.lastname: Kim
authors.forename: Sun-Chul
authors.initials: SC
authors.lastname: Hwang
authors.forename: Soo-Bin
authors.initials: SB
authors.lastname: Im
authors.forename: Dong-Seong
authors.initials: DS
authors.lastname: Shin
authors.forename: Won-Han
authors.initials: WH
authors.lastname: Shin
keywords: Chronic subdural hematoma; Coronal suture; Craniostomy