Burr Hole versus Twist Drill Craniostomy for Chronic Subdural Hematoma: A Blinded Randomized Study
Journal Title: Journal of Medical Science And clinical Research - Year 2018, Vol 6, Issue 8
Abstract
Objective: To compare outcomes of Burr hole craniostomy (BHC) and Twist drill craniostomy (TDC) for unilateral chronic subdural hematoma (CSDH). Methods: A prospective blinded randomized study was conducted in King George Medical University, Lucknow, India from April 2010 to September 2011 in 110 adult patients of unilateral hemispheric CSDH and were randomly assigned into two groups of 55 patients. One group underwent BHC and the other underwent TDC. Patients were followed up at 1, 3, and 6 month. The primary outcome variable was recurrence, other variables compared were mortality, morbidity and surgical complications, duration of hospital stay and cure rates. This study was started after ethical approval from national authorities. Results: The two groups were similar in demographic characteristics, clinical presentations and predisposing factors but, the preoperative clinical and radiological data favored burr hole craniostomy group [mean GCS at admission {13.36 vs 12.6(p= 0.032)}, mean thickness of hematoma {21.44 vs 23.27(p=0.033)}, density of hematoma (p=0.020), mean midline shift 11mm vs 10mm (p=0.071 nonsignificant) in twist drill and burr hole craniostomy groups respectively]. Recurrence rates were 5.4% and 1.8%(p=0.618), morbidity 16.3% and 10.9%(p=0.405), mortality 5.5% and 0%(p=0.253), mean duration of hospital stay 7.6 days and 6.36 days(p=0.074), and contralateral chronic SDH 5.5% and 3.6%(p=0.618) respectively in twist drill and burr hole craniostomy groups, showing non-significant difference however, cure rates (GOS 5 at 1 month) was higher in burr hole group (97% vs 84%, p=0.025). Conclusions: BHC and TDC both are equally effective procedure for treatment of chronic subdural hematoma. TDC can be an effective bed side procedure in moribund patients where patient cannot be immediately shifted to operating room for urgent decompression
Authors and Affiliations
Dr Mallika Sinha
Maternal and Perinatal Outcome of Preterm Premature Rupture of Membrane
Background; preterm premature rupture of membrane is associated with significant risks of maternal and perinatal morbidity and mortality, therefore the suitable decision play an important role in the management of this c...
Maternal Mortality in a Tertiary Care Hospital of Central India: A 5 years Review
The key to the progress of a country lies in reducing it’s maternal morbidity and mortality. The maternal mortality rate has gone down since 1980 however it has still not achieved the target level hence to give a better...
Molluscum Contagiosum–Like Lesions in Histoid Leprosy in a 35-Year-Old Indian male
Histoid leprosy is a rare but well-defined entity with specific clinical, histopathological, and bacteriological features. It is considered an uncommon variant of lepromatous leprosy that usually follows treatment failur...
Effect of Antenatal Betamethasone on Fetal and Uteroplacental Blood Flow Velocity Waveforms in Preterm Pregnancies with Intra Uterine Growth Restriction
Background: Antenatal administration of corticosteroids has been recommended as it promotes fetal lung maturation, reduces the incidence and severity of respiratory distress syndrome and other complications. The objectiv...
Antibacterial Prescription Pattern in Medical and Surgical Intensive Care Units of a Tertiary Care Hospital
Objectives: This study was conducted to assess the prescribing pattern of Antibacterial agents in Medical and Surgical ICU of a tertiary care teaching hospital in Maharashtra and to suggest necessary modifications in pre...