Twist-drill craniostomy for the treatment of chronic subdural hematoma.

The choice of the initial surgical method for treating the patient with CSH is influenced by the patient's neurologic status at the time of presentation, associated medical factors, and the surgeon's experience in the management of these patients. The outcome data suggest that twist-drill craniostomy with closed-system catheter drainage results in an equivalent or superior outcome to the historical results of craniotomy with membranectomy. Craniotomy remains the treatment of choice when the admitting computerized tomographic scan demonstrates a significant hyperdense component suggesting the presence of solid or mixed hematoma.