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Minimally invasive decompression of chronic subdural haematomas using hollow screws: efficacy and safety in a consecutive series of 320 cases

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Abstract

Background

Chronic subdural haematoma (cSDH) is a frequent pathology in neurosurgery. Surgical treatment varies widely and is often characterised by repeated decompression. Therapeutic efficacy was evaluated by clinical symptom relief and haematoma reduction on preoperative and postoperative CT scans.

Methods

We investigated a consecutive series of 320 cases of cSDH between 2006 and 2010. In this series, the first- and second-line treatments were performed via hollow-screw placement under local anaesthesia, whereas enlarged burr holes under general anaesthesia were used as third-line treatment.

Results

In general, 63.3% of cases were sufficiently treated by a single operation, while 16.2% needed a second procedure with hollow screws. Only 20.5% needed open surgery by an enlarged burr hole with membranectomy under general anaesthesia. After the first operation, initial symptoms improved in 80.3% of cases, remained unchanged in 15.5% and worsened in 4.2% of cases. Mean age was 74.6 ± 12.1 years, with only one case of severe surgery-related complication.

Conclusions

Initial placement of hollow screws under local anaesthesia is a safe and sufficient treatment in most cases, and should be favoured as first-line treatment in patients with cSDH, since these patients are often of older age and present with distinct comorbidity.

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Acknowledgements

This study was completely financed by institutional grants from the Department of Neurosurgery.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, Technische Universität München, Munich, Germany

    Sandro M. Krieg, Fanny Aldinger, Michael Stoffel, Bernhard Meyer & Juergen Kreutzer

  2. Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    Bernhard Meyer

Authors
  1. Sandro M. Krieg
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  2. Fanny Aldinger
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  3. Michael Stoffel
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  4. Bernhard Meyer
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  5. Juergen Kreutzer
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Corresponding author

Correspondence to Bernhard Meyer.

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Comments

This paper presents the results of a retrospective analysis of a quite large series of chronic subdural haematomas treated by hollow-screw drainage. It is an interesting study, although retrospective, and therefore with the drawbacks associated with such a design. The analysis focuses on recurrence rate and explores the influence of factors such as initial CT density, presence of septations and coagulation state on the therapeutic course and outcome.

CSDH, as the authors note, is a common entity in neurosurgical practice. It deserves to be noted, and awareness of recurrences and problems in the treatment of cSDH is important. As such, this manuscript is welcomed.

Domenico d’Avella

Padova, Italy

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Krieg, S.M., Aldinger, F., Stoffel, M. et al. Minimally invasive decompression of chronic subdural haematomas using hollow screws: efficacy and safety in a consecutive series of 320 cases. Acta Neurochir 154, 699–705 (2012). https://doi.org/10.1007/s00701-012-1294-4

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  • DOI: https://doi.org/10.1007/s00701-012-1294-4

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