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Acta Neurochirurgica

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01-12-2021 | Subdural Hematoma | Original Article - Brain trauma

Twist drill craniostomy vs burr hole drainage of chronic subdural hematoma: a systematic review and meta-analysis

Authors: Karan J. Yagnik, Anshit Goyal, Jamie J. Van Gompel

Published in: Acta Neurochirurgica | Issue 12/2021

Abstract

Introduction

There is a clinical equipoise between burr hole drainage (BHD) or twist drill craniotomy (TDC) as initial surgical intervention in patients with chronic subdural hematoma (cSDH). Moreover, the impact of type of postoperative drainage is not well elucidated. We performed a systematic review and meta-analysis comparing outcomes following BHD and TDC for initial surgical management in cSDH and to understand the impact of negative suction drainage with TDC.

Methods

A literature search was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies that directly compared TDC and BHD. The following outcomes were compared between TDC and BHD: mortality, recurrence, reoperations, complications, and cure rates. Subgroup analysis was performed to determine impact of negative suction drainage with TDC.

Results

Sixteen articles (n = 1,235; TDC: 663; BHD: 591) met inclusion criteria. Although complications (OR: 0.68, 95% CI: 0.38–1.23, p = 0.21; I² = 31%), recurrence (OR: 1.16, 95% CI: 0.84–1.62, p = 0.37; I² = 28%), cure (OR: 1.11, 95% CI: 0.72–1.72, p = 0.64, I² = 34%), and mortality rates (OR: 1.20, 95% CI: 0.60–2.41; p = 0.61; I² = 0%) were not significantly different between the two groups, TDC was associated with a higher reoperations than BHD (OR: 1.48, 95% CI:1.01–2.16, p = 0.04; I² = 41%). Subgroup analysis demonstrated that TDC with negative suction drainage conferred equivalent reoperation rates as BHD (OR: 0.75, 95% CI: 0.24–2.35; p = 0.62; I² = 65%); however, TDC without negative suction was associated with higher reoperations (OR: 1.62, 95% CI: 1.08–2.42; p = 0.02; I² = 40%).

Conclusion

A systematic review and meta-analysis of available literature directly comparing TDC and BHD for primary evacuation of cSDH did not demonstrate clear superiority of either technique, although reoperations may be higher following TDC. Use of negative suction drainage with TDC may lead to similar rates of reoperation as BHD.

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Title: Twist drill craniostomy vs burr hole drainage of chronic subdural hematoma: a systematic review and meta-analysis
Authors: Karan J. Yagnik
Anshit Goyal
Jamie J. Van Gompel
Publication date: 01-12-2021
Publisher: Springer Vienna
Keywords: Subdural Hematoma
Craniotomy
Local Anesthesia in Dentistry
Published in: Acta Neurochirurgica / Issue 12/2021
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-021-05019-3

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Twist drill craniostomy vs burr hole drainage of chronic subdural hematoma: a systematic review and meta-analysis

Abstract

Introduction

Methods

Results

Conclusion

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Abstract

Introduction

Methods

Results

Conclusion

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