A Comparative Study Of Twist Drill Craniotomy And Burr Hole Craniotomy In Patients Of Chronic Sub-Dural Hematoma Attending A Tertiary Care Centre Of Bihar

Abstract

Introduction: Chronic subdural hematoma (CSDH) is one of the most commonly encountered neurosurgical conditions, common in elderly population. It may be associated with substantial morbidity and mortality and its incidence is estimated to be 13.1 cases per 100,000 populations in recent studies. This study aimed to compare recurrence rate, mortality, morbidity, surgical complications, and duration of hospital stay of these two procedures. Methodology: A study comparing burr hole craniostomy (BHC) with twist drill craniostomy (TDC) for unilateral hemispheric CSDH was carried out over a period of one year, from February 2021 to January 2022 in the Department of Neurosurgery, Patna Medical College & Hospital, Patna, Bihar. 50 unilateral CSDH patients of more than 10 mm thickness on CT scan were included, and thin CSDH, bilaterally significant CSDH, radiologically doubtful hygroma or empyema and infantile subdural collection were excluded. Two groups were randomly created out of these 50 cases with 25 patients each. Patients from one group A underwent BHC and patients of another group underwent TDC. All patients were followed up at 1, 3 and 6 months. Protocol was approved by the Institutional Ethical Committee and a written informed consent was obtained from each patient or next of kin before participation in the study was confirmed. All the statistical analysis was done using Statistical Package for Social Sciences (IBS, Chicago) ver. 16.0. Results: The mean (SD) of the patients in groups TDC and BHC were 55.1(11.3) years and 57.5 (12.2) years, respectively. Overall, there was a male preponderance with a male to female ratio of 5.25:1. Most common predisposing factor was trauma (70%) followed by hypertension (14%), alcoholism (8%), Diabetes mellitus (6%) and only one patient (2%) had a history of anticoagulant use. On pre-operative assessment, mean GCS at admission in group TDC was 12.3 and that in group BHC was 13.1. Mean (SD) thickness of hematoma in both the groups were 24.1(4.3) mm and 22.4(5.1) mm, respectively. Mean (SD) midline shift was 12.1(3.2) mm and 10.3(2.9) mm in group TDC and BHC respectively. Conclusion: BHC and TDC both are equally effective procedures for chronic SDH with respect to recurrence rate, morbidity and mortality. Follow up up-to 3 months in cases of unilateral chronic subdural hematoma is sufficient.