High-speed drill craniostomy as a minimally invasive method of chronic subdural hematoma management. Preliminary results of a pilot study

Objectives: The objective of this study was to assess the safety and efficiency of minimally invasive high-speed drill craniostomy in the treatment of chronic subduralhematomas.Study design: The study was designed as a retrospective case series study.Patients and Methods: The patients with compressive chronic subdural hematomas were treated by minimally invasive high-speed craniostomy performed underlocal anesthesia or conscious sedation. A minimal skin incision was followed by a single high-speed drill hole placement in the frontal or parietal region, over the area of maximal hematoma thickness. After hematoma aspiration, a 1.9 mm silicone catheter was placed in subdural space and connected to gravity-assisteddrainage. Patients were ambulatory immediately after surgery. Data on clinical course and outcome were recorded and analyzed.Results: There were 23 patients (5 female, 21.7%) included in the study. The median patient age was 77.5 years (interquartile range 67 - 83). Six (26.1%) of the patients had bilateral subdural hematomas. Septated/multiloculated hematomas were observed in 6 (26.1%) patients. Heterodense hematomas denoting more recent bleeding were recorded in 16 (69.5%) patients. The median duration of subdural drainage was 4 days (interquartile range 3 to 5). The median length of hospital stay was 9.5 days (interquartile range 6 - 16). One patient died of sepsis following a nosocomial respiratory infection. One patient developed a wound infection with subdural empyema, requiring subsequent craniotomy. One patient had deep venous thrombosis and pulmonary embolism. In all patients, postoperative CT scans showed a significant reduction of hematoma volume and midline shifting. No postoperative seizures were observed.Conclusion: High-speed drill craniostomy is a safe, simple, straightforward, and effective treatment for the management of chronic subdural hematomas, including multiloculated and heterodense lesions. Elderly patients could most benefit from such a procedure, avoiding general anesthesia, prolonged intracranial procedures, and lengthy hospital stays.