Turkish Neurosurgery 2013 , Vol 23 , Num 1
Modified Twist Drill Technique in the Management of Chronic Subdural Hematoma
Yad Ram YADAV1, Sharda YADAV2, Vijay Singh PARIHAR3
1NSCB Medical College Jabalpur MP India, Department of Neurosurgery, Jabalpur, India
2Apex Hospital and Research Centre, Department of Neurosurgery, Jabalpur, India
3NSCB Medical College Jabalpur MP India, Department of Neurosurgery, Jabalpur, India
DOI : 10.5137/1019-5149.JTN.6655-12.1 AIM: 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.

MATERIAL and 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.

CONCLUSION: Our modified technique of twist drill drainage is inexpensive, simple, safe and effective alternative technique in the treatment of CSDH. Keywords : Chronic subdural hematoma, Intracranial subdural hematoma, Subdural hematoma, Minimally invasive technique, Operative surgical procedure

Corresponding author : Yad Ram Yadav, yadramyr@yahoo.com