Artikel
Twist drill procedure for chronic subdural hematoma evacuation- an analysis of predictors for treatment success
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Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: Twist drill craniostomy (TDC) is a “minimally invasive” and cost-effective technique to treat chronic subdural hematomas (CSDH). Predictors for treatment sufficiency such as imaging characteristics, hematoma volume, and drainage volume - are not established so and are purpose of this analysis.
Methods: We retrospectively evaluated all data of CSDH patients undergoing TDC in our institution between January 2010 and December 2013. We analyzed imaging characteristics (extension and composition), volumetrically calculated pre- and postoperative hematoma volume, measured drainage volume, and clinical course. As volumetric analysis, we evaluated the hematoma volume on the available pre- and post-treatment CT via Osirix 7.0 (Advanced open-source PACS Workstation, ©Pixmeo SARL, Berne, Switzerland). For volumetric assessment, we transferred the respective DICOM data of all included patients into the Osirix Workstation and identified the hematoma on each axial image. Finally, a 3D image of individual hematoma was calculated to define its extension and volume. Treatment was defined as sufficient if definitive treatment was achieved via a single TDC (TDC-1) and insufficient if more than one TDC was needed (TDC-X). The need for open surgical evacuation was defined as treatment failure.
Results: Data of 233 patients undergoing 387 TDCs were available for our study. Treatment was sufficient in 124 (32%), insufficient in 136 (35%), and failed in 127 (33%) procedures. Using the median-split-method, sufficient treatment was achieved more frequently in smaller hematomas (p<0.05). Treatment sufficiency was neither correlated with hematoma image characteristics (presence of membranes: p=0.11, extent of chronification: p=0.55), nor with the respective drainage volume (p=0.95). Residual hematoma volume was consistently higher than expected by drainage calculation (p<0.05).
Conclusion: TDC is an effective treatment option for CSDH. Sufficient treatment was more common in smaller hematomas with an associated smaller residual hematoma. Failure of brain re-expansion after TDC may increase the treatment failure rates. In these cases, an open surgical evacuation might accelerate treatment and clinical recovery.