Burr-hole versus twist-drill drainage for the evacuation of chronic subdural haematoma: a comparison of clinical results.

BACKGROUND: Most neurosurgeons remove clinically symptomatic subdural haematomata, but the techniques they choose remain controversial.

METHOD: The results from sixty-two patients diagnosed with chronic subdural haematoma were evaluated for technique, postoperative computerized tomography (CT) scan results, and complications.

RESULTS: Eleven patients had haematomata evacuated using twist-drill plus drain, 37 patients had haematomata evacuated with burr-hole only, and 14 patients were evacuated with burr-hole plus drain. Of the patients who underwent twist-drill and closed system drainage (CSD), 43% had smaller lesions on CT follow-up scans, as compared with 74% of those who underwent the burr-hole only procedure, and 65% with burr-holes with drains. Clinical outcome results showed that 64% of twist-drill and CSD patients deteriorated as compared with 16% of those with burr-hole only and 7% with burr-holes and CSDs. Sixty-four per cent of twist-drill patients required repeat evacuations as compared with 11% of those with burr-holes only, and 7% with burr-holes plus drains.

CONCLUSION: The results at our institution indicate that burr-hole evacuation for chronic subdural haematoma is superior to twist-drill evacuation with respect to clinical outcomes and complications.