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Management of chronic subdural hematoma with twist-drill craniostomy: Report of 213 patients

Abstract:

Objectives: Controversies regarding the surgical management of chronic subdural hematoma still remain. The objective of the present study was to describe our experience with twist-drill craniostomy. Patients and methods: Two hundred and thirteen patients were treated at the "Teodoro Maldonado Carbo" and "Alcívar" facilities between January 1992- February 2005. The surgical technique consisted of a twist-drill made under local anesthesia at the patient's bedside. We administered the Markwalder grading scale and the Glasgow outcome scale to assess treatment results. Clinical outcome, complications and relapse were measured. Results: The etiology was traumatic in 65% of cases. At admission, 79% scored 2 of the Markwalder grading scale. Nine percent of the patients displayed complications. The chronic subdural hematoma persisted in 8%; they were treated again with another twist-drill craniostomy with favorable results. At six months, 97.6% reached 5 in the Glasgow outcome scale. Conclusions: Twist-drill craniostomy is a less time consuming, safe, effective, and cost-efficient method for the treatment of chronic subdural hematoma.