Work

Twist-drill craniostomy with pressure-controlled fibrinolytic irrigation therapy reduces recurrence of chronic subdural hematomas: initial experience in 16 cases

Year: 2025

Type: article

Abstract: BACKGROUND: Chronic subdural hematoma (cSDH) is prevalent in the elderly, frail, and those on antithrombotic therapy, often resulting in significant morbidity and mortality. Recurrence and reoperation rates are substantial concerns. Emerging evidence suggests that irrigation, drainage, and possibly fibrinolytic therapy, may improve reoperation rates. OBJECTIVE: To explore safety and efficacy of twist-drill craniostomy (TDC) with pressure-controlled fibrinolytic irrigation therapy (TDC-FIT) in reducing recurrence rates of cSDH compared to conventional TDC with subdural passive drainage. METHODS: A retrospective study included 314 patients treated with TDC and 16 patients treated with TDC-FIT between January 2021, and March 2024. The primary endpoint was the reoperation rate due to symptomatic recurrence or persistence of cSDH at 6 months. Secondary endpoints included hematoma resolution, perioperative complications, and the impact of antithrombotic therapy and preoperative membrane formation. RESULTS: Reoperation was required in 107 (34.1 %) TDC patients and in one (6.3 %) TDC-FIT patient (P = .026). Hematoma membranes (OR 2.6, 95 % CI 1.6-4.3, P < .001) and dual antithrombotic therapy (OR 10.3, 95 % CI 1.1-93.3, P = .041) were significantly associated with reoperation in the TDC cohort. TDC-FIT showed superior hematoma resolution with a similar complication profile and functional outcome. TDC-FIT patients had a significantly lower reoperation rate despite a higher presence of hematoma membranes (75 % vs. 34.7 %, P = .002). CONCLUSION: Preliminary data on TDC-FIT suggests improved reoperation rate and membranous hematoma resolution with comparable safety profiles to conventional TDC. Further prospective studies are needed to validate these findings in larger cohorts.

Source: Clinical Neurology and Neurosurgery

DOI: 10.1016/j.clineuro.2025.108850