title: An improved electronic twist-drill craniostomy procedure with post-operative urokinase instillation in treating chronic subdural hematoma.
abstract: OBJECTIVE
  Twist-drill craniostomy (TDC) with closed-system drainage is a less invasive surgical technique for the treatment of chronic subdural hematoma (CSDH), but results in a higher disease recurrence rate. Therefore, we aimed to modify the TDC procedure in order to reduce the recurrence rate and further decrease complications.
  
  
  METHODS
  We retrospectively reviewed 230 cases of standard CSDH in 202 patients treated in our hospital between January 2006 and December 2013. We employed a new TDC device called micro-steel-needle-tube-bit for puncture and drainage. We chose an entry point 0.5cm anterior to the coronal suture at the superior temporal line and maintained post-operative drainage with urokinase instillation into the hematoma cavity. Clinical performance was assessed and compared by the Markwalder Grading Scale (MGS) score during the pre-operative period and at discharge. Recurrence of CSDH and complications were also recorded.
  
  
  RESULTS
  Mean operation time was only 8.9 (6-13) min. Mean catheter indwelling duration and hospital stay were 1.18 (271/230, 1-3) and 2.27 (458/202, 2-9) days, respectively. The average frequency of urokinase instillation was 1.14 (262/230, 1-3) times. Intracerebral and sub-arachnoid hemorrhages were found in one patient, but were not in the puncture pathway. No perioperative deaths occurred. Recurrence was observed in only one patient at 28 days post-operation. Among 202 patients, 193 (95.54%) showed improved clinical symptoms and neurological function, and significantly lower MGS scores at discharge than pre-operation (0.13±0.45 vs. 1.37±0.55, P<0.01).
  
  
  CONCLUSIONS
  In conclusion, electric TDC with micro-steel-needle-tube-bit at the pre-coronal suture entry point might be a safer, simpler, and faster mini-invasive surgical procedure for CSDH treatment. Post-operative drainage with instillation of urokinase could dramatically shorten drainage time and decrease recurrence rate.
authors.affiliation: The Department of Neurosurgery, Longyan First Hospital Affiliated to Fujian Medical University, Longyan 364000, China. Electronic address: 13950866325@139.com.
authors.forename: Jing
authors.initials: J
authors.lastname: Lu
authors.affiliation: The Department of Neurosurgery, Longyan First Hospital Affiliated to Fujian Medical University, Longyan 364000, China.
authors.forename: Dongwei
authors.initials: D
authors.lastname: Shen
authors.affiliation: The Department of Neurosurgery, Longyan First Hospital Affiliated to Fujian Medical University, Longyan 364000, China.
authors.forename: Fangjin
authors.initials: F
authors.lastname: Hu
authors.affiliation: The Department of Neurosurgery, Longyan First Hospital Affiliated to Fujian Medical University, Longyan 364000, China.
authors.forename: Jianjun
authors.initials: J
authors.lastname: Zhou
authors.affiliation: The Department of Neurosurgery, Longyan First Hospital Affiliated to Fujian Medical University, Longyan 364000, China.
authors.forename: Folin
authors.initials: F
authors.lastname: Lan
authors.affiliation: The Department of Neurosurgery, Longyan First Hospital Affiliated to Fujian Medical University, Longyan 364000, China.
authors.forename: Dongbing
authors.initials: D
authors.lastname: Guo
authors.affiliation: The Department of Neurosurgery, Longyan First Hospital Affiliated to Fujian Medical University, Longyan 364000, China.
authors.forename: Tianqing
authors.initials: T
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D003399:Craniotomy / Q000379:methods; D004322:Drainage / Q000379:methods; D005260:Female; D020200:Hematoma, Subdural, Chronic / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D014568:Urokinase-Type Plasminogen Activator
keywords: Chronic subdural hematoma; Electronic twist-drill craniostomy; Pre-coronal suture; Urokinase instillation