Jing Lu1, Dongwei Shen2, Fangjin Hu2, Jianjun Zhou2, Folin Lan2, Dongbing Guo2, Tianqing Liu2. 1. The Department of Neurosurgery, Longyan First Hospital Affiliated to Fujian Medical University, Longyan 364000, China. Electronic address: 13950866325@139.com. 2. The Department of Neurosurgery, Longyan First Hospital Affiliated to Fujian Medical University, Longyan 364000, China.
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). CONCLUSION: 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.
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). CONCLUSION: 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: Elena I Fomchenko; Emily J Gilmore; Charles C Matouk; Jason L Gerrard; Kevin N Sheth Journal: Curr Treat Options Neurol Date: 2018-07-18 Impact factor: 3.598
Authors: Raj S Chandran; Milesh Nagar; M S Sharmad; Rajmohan B Prabhakar; Anil K Peethambaran; Shailesh Kumar; Saurabh Sharma; Sourabh K Jain Journal: J Neurosci Rural Pract Date: 2017 Jul-Sep