Twist Drill Craniostomy and Closed System Drainage of Chronic and Subacute Subdural Hematomas

Abstract Based on reports in the literature on the success and low morbidity of twist drill craniostomy (TDC) and closed system drainage (CSD) for chronic subdural hematomas, a prospective study was initiated in 1981 and included all symptomatic patients presenting with a history and clinical and computed tomographic (CT) findings consistent with subacute or chronic subdural hematoma. A total of nine patients were treated with TDC and CSD as the initial procedure. An asymptomatic or progressively improving patient with greater than 50% reduction in subdural size by repeat CT scan was set as the end point of therapy. There were no complications, all patients improved with drainage, and seven were cured by this method alone. The results are compared retrospectively to surgically treated patients, and an overall decrease in morbidity and length of hospitalization are noted. The technique and CT scan correlations are described, and the rationale for use of this method is discussed in terms of our current understanding of the pathophysiology and complications of the disease.

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Xenon-enhanced Computed Tomographic Measurement of Cerebral Blood Flow in Patients with Chronic Subdural Hematomas

Neurosurgery ◽

10.1227/00006123-199010000-00009 ◽

1990 ◽

Vol 27 (4) ◽

pp. 554-561 ◽

Cited By ~ 33

Author(s):

Akira Tanaka ◽

Shinya Yoshinaga ◽

Masato Kimura

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Ct Scan ◽

Clinical Symptoms ◽

Chronic Subdural Hematoma ◽

Ct Scans ◽

Brain Shift ◽

Computed Tomographic ◽

Mental Disturbance ◽

Subdural Hematomas

Abstract We compared clinical symptoms with extent of brain shift on computed tomographic (CT) scans and quantitative and three-dimensional measurements of cerebral blood flow (CBF) on xenon-enhanced CT scans in 10 patients with chronic subdural hematomas. Five patients had only headache and minimal or no brain shift on a CT scan. The other five had hemiparesis and/or mental disturbance in addition to headache and moderate or severe brain shift on a CT scan. The mean hemispheric CBF decreased about 7% in patients with headache and about 35% in patients with hemiparesis and/or mental disturbance. It decreased also on the side without the hematoma. The CBF reduction was always more pronounced in the putamen and thalamus than in the cortex. On the contrary, the cortex CBF was mostly preserved or even elevated in both groups of patients. We speculate that CBF reduction in patients with a chronic subdural hematoma occurs initially in central cerebral areas like the basal ganglia and thalamus, and then extends to the entire hemisphere including the cortex as brain compression and displacement progress. Central cerebral area involvement might be more responsible for clinical symptoms than the cortex.

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Management of chronic subdural hematoma: Burr hole versus twist drill – A prospective study

Asian Journal of Neurosurgery ◽

10.4103/ajns.ajns_99_16 ◽

2018 ◽

Vol 13 (2) ◽

pp. 319 ◽

Cited By ~ 2

Author(s):

RamKumar Goyal ◽

Biswaranjan Nayak ◽

Rajiv Maharshi ◽

DebadulalDas Bidhar ◽

Sunil Panchal ◽

...

Keyword(s):

Prospective Study ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Burr Hole ◽

Twist Drill ◽

A Prospective Study

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486 Prognostic value of pet-ct scan on survival outcomes of advanced-staged ovarian cancer patients treated with neoadjuvant chemotherapy: a prospective study

10.1136/ijgc-2020-esgo.50 ◽

2020 ◽

Author(s):

Stamatios Petousis ◽

Anne-Laure Cazeau ◽

Amandine Crombe ◽

Chrysoula Margioula-Siarkou ◽

Michel Kind ◽

...

Keyword(s):

Ovarian Cancer ◽

Neoadjuvant Chemotherapy ◽

Prospective Study ◽

Ct Scan ◽

Cancer Patients ◽

Prognostic Value ◽

Survival Outcomes ◽

Pet Ct ◽

A Prospective Study ◽

Pet Ct Scan

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Correlation of the Beta-Trace Protein and Inflammatory Cytokines with Magnetic Resonance Imaging in Chronic Subdural Hematomas : A Prospective Study

Journal of Korean Neurosurgical Society ◽

10.3340/jkns.2015.57.4.235 ◽

2015 ◽

Vol 57 (4) ◽

pp. 235 ◽

Cited By ~ 3

Author(s):

Ki-Su Park ◽

Seong-Hyun Park ◽

Sung-Kyoo Hwang ◽

Chaekyung Kim ◽

Jeong-Hyun Hwang

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Prospective Study ◽

Inflammatory Cytokines ◽

Resonance Imaging ◽

Subdural Hematomas ◽

A Prospective Study

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Computed tomography scan findings in eclampsia: a prospective study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184267 ◽

2018 ◽

Vol 7 (11) ◽

pp. 4432

Author(s):

K. S. Raja Rajeswari ◽

R. Niranjana

Keyword(s):

Computed Tomography ◽

Prospective Study ◽

Ct Scan ◽

Brain Infarction ◽

Cortical Blindness ◽

Obstetrics And Gynaecology ◽

A Prospective Study ◽

Ct Finding ◽

Brain Haemorrhage ◽

Tomography Scan

Background: Eclampsia is a leading cause of maternal death, with classical neurological symptoms that include headache, nausea, vomiting, cortical blindness, coma and convulsions. Computed tomography (CT) scan helps in diagnosing and management of eclampsia in pregnant women. The present study was done with the objective to analyse the findings of CT scan of brain in eclampsia, to identify the prevalence of neurovascular complications in these cases and to determine if these findings can be of value in determining the prognosis of this disorder.Methods: This was a prospective study done on 100 patients with eclampsia. All of the 100 patients were screened with CT scan brain at Institute of Obstetrics and Gynaecology, Egmore, Chennai during the period from August 2008 to August 2009. All the data were analyzed and compared between the groups of positive CT scan and negative CT scan observations.Results: Out of 100 patients, positive CT scan findings were noticed in 15 patients. Of them, 7 patients expired, and 8 patients survived after treatment. Of the expired patients (7), 5 of them expired due to brain haemorrhage, and 1 patient died with cerebral oedema and 1 with brain infarction. Cerebral odema (46%) was the most common positive CT finding. Parietal region of brain was the most common (40%) affected area.Conclusions: CT scan of brain provides valuable information in determining the prognosis and the prevalence of neurovascular complications in Eclampsia.

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Performance of computed tomographic colonography for the screening of colorectal polyp in acromegalic patients: a prospective study

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032009000200003 ◽

2009 ◽

Vol 46 (2) ◽

pp. 90-96 ◽

Cited By ~ 5

Author(s):

Odery Ramos Jr. ◽

César Luiz Boguszewski ◽

Sandra Teixeira ◽

Ricardo De Bem ◽

Benito Parolim ◽

...

Keyword(s):

Prospective Study ◽

Virtual Colonoscopy ◽

Colorectal Polyp ◽

Colorectal Polyps ◽

High Risk Group ◽

Conventional Colonoscopy ◽

Intestinal Loop ◽

Computed Tomographic Colonography ◽

Computed Tomographic ◽

A Prospective Study

CONTEXT: Acromegalic patients have better chances to develop colorectal polyps and cancer and, considered a high-risk group, need to undergo frequent screening examinations. Moreover, in acromegalia, the increased bowel length and the intestinal loop complexity can lead to higher levels of technical difficulties and increase the risks of complications at conventional colonoscopy. Computed tomographic colonography, also known as virtual colonoscopy, is an innovative and secure technology which is revolutionizing the diagnosis of colon and rectum neoplasias. OBJECTIVE: To analyze computed tomographic colonography performance for the screening of colorectal polyps in acromegalic patients. METHODS: A prospective study of 21 asymptomatic acromegalic patients, 12 male and 9 female, average age 49, who underwent computed tomographic colonography and conventional colonoscopy. Computed tomographic colonography was performed with a GE Helical Multislice Computed Tomography Apparatus. Conventional colonoscopy was performed in the same day, without previous knowledge of the computed tomographic colonography diagnostics. The study evaluated the capacity of computed tomographic colonography to detect patients with colorectal polyps and identify each colorectal lesion described by the colonoscopy. RESULTS: In two patients (2/21), conventional colonoscopy was incomplete. However, in all patients computed tomographic colonography was complete. In Phase I ("per patient"), computed tomographic colonography diagnosed eight of the nine patients with colorectal polyps and showed 88% sensitivity, 75% specificity and 81% accuracy. In Phase II ("per polyp"), out of the 21 acromegalic patients included in this study, 12 presented normal findings at conventional colonoscopy. A total of 19 polyps were identified in 9 patients. Ten of the 19 polyps were smaller than 10 mm, and 9 were equal to or larger than 10 mm. Computed tomographic colonography identified 7 of the 9 polyps >10 mm described by conventional colonoscopy and only 6 of the 10 small polyps identified at conventional colonoscopy were detected by computed tomographic colonography. The histological analysis of resected lesions revealed 12 tubular adenomas, 6 hyperplastic polyps and 1 colonic tubulo-villous adenoma with an adenocarcinoma focus. CONCLUSION: The authors present the first reports of computed tomographic colonography in the screening of colorectal polyps in acromegalic patients. In this study, computed tomographic colonography was performed without complications and a complete and safe colorectal evaluation was possible in all acromegalic patients. Moreover, computed tomographic colonography presented good sensitivity, specificity and accuracy for the identification of acromegalic patients with polyps of any size and better results in the diagnosis of large polyps, when they were compared to small polypoid lesions.

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