Modified twist drill technique in the management of chronic subdural hematoma.
OBJECTIVE
Burr-hole craniostomy is the most efficient and safe choice for surgical     drainage of chronic subdural hematoma (CSDH). Although the twist-drill drainage     is also relatively safe and time-saving, it carries the risk of inadequate     drainage, brain penetration and hematoma formation. Our modified technique helps     in avoiding bleeding and brain penetration.


METHODS
The preferred     sites for twist drill were the most curved parts on the cranium. Normal drilling     at about 90 degree angle was done on the most curved surfaces while it was at     about 60 degree angles on flat surface. This angled drilling and the curved     guide wire (hooked in the distal blind end of infant feeding tube), helped to     guide infant feeding tube in the hematoma cavity. Dura matter was coagulated     using insulated wire.


RESULTS
There was no procedure related hematoma, brain     penetration and mortality in any of the 50 patients managed by the modified     technique. Infant feeding tube was properly positioned in all the cases. Burr     hole evacuation was done in 7 cases (14%) due to inadequate evacuation of the     hematoma after TDC.


CONCLUSIONS
Our modified technique of twist drill drainage     is inexpensive, simple, safe and effective alternative technique in the     treatment of CSDH.
NSCB Medical College Jabalpur MP India, Department of Neurosurgery, Jabalpur, India.
Yad Ram
YR
Yadav
Sharda
S
Yadav
Vijay Singh
VS
Parihar
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003399:Craniotomy / Q000295:instrumentation* / Q000379:methods*; D004322:Drainage / Q000295:instrumentation / Q000379:methods; D004750:Enteral Nutrition; D004867:Equipment Design; D005260:Female; D020200:Hematoma, Subdural, Chronic / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D011446:Prospective Studies; D012886:Skull / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult