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).

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: Jing Lu, Dongwei Shen, Fangjin Hu, Jianjun Zhou, Folin Lan, Dongbing Guo, Tianqing Liu
• Journal: Clinical neurology and neurosurgery (Clin Neurol Neurosurg) Vol. 136 Pg. 61-5 (Sep 2015) ISSN: 1872-6968 [Electronic] Netherlands
• PMID: 26067723 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Elsevier B.V. All rights reserved.

Chemical References

• Urokinase-Type Plasminogen Activator

Topics

• Adult
• Aged
• Craniotomy (methods)
• Drainage (methods)
• Female
• Hematoma, Subdural, Chronic (diagnosis, drug therapy, surgery)
• Humans
• Male
• Middle Aged
• Postoperative Period
• Retrospective Studies
• Treatment Outcome
• Urokinase-Type Plasminogen Activator (therapeutic use)