Twist-drill craniostomy with hollow screws for evacuation of chronic subdural hematoma

Object. The incidence of chronic subdural hematoma (CSDH) is expected to increase substantially over the next 25 years. Continuing refinement of techniques for surgical evacuation is essential for optimizing patient outcomes. A novel technique involving a hollow screw, which is threaded through a twist-drill hole in the cranium and then connected to a closed drainage system, has been increasing in popularity. The aim of this systematic review is to collate and analyze the published experience with this novel technique and to evaluate its efficacy in comparison with the other surgical treatment methods. Methods. This systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and has been registered with the PROSPERO International Prospective Register of Systematic Reviews (registration number CRD42013003544). MEDLINE, Web of Knowledge, EMBASE, and the Cochrane Database of Systematic Reviews were searched for published series involving more than 10 patients treated with these new techniques. Results. Nine eligible studies were found (6 case series and 3 case-control studies) comprising 796 patients treated with these new techniques. Pooled analysis showed a "success rate" of 77.6% (95% CI 74.6%-80.4%), recurrence rate of 22.4%, and in-hospital mortality of 1.4%. Conclusions. This systematic review adds further evidence to the pool of data assessing the safety and efficacy of the use of this novel, minimally invasive technique for the treatment for CSDH. Overall, twist-drill craniostomy with hollow screws appears to be safe and effective. Class I evidence is necessary to optimize the surgical management of patients with CSDH.