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 non-significant) 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.

Keywords: Burr Hole craniostomy, Twist Drill craniostomy, Chronic subdural hematoma, Randomized study.

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Dr Mallika Sinha

Assistant Professor, Neurosurgery Bhopal  Memorial  Hospital & Research Centre, Bhopal, MP, India