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

Cilj: Cilj je ovoga istraživanja procjena učinkovitosti i sigurnosti trepanacije visokoobrtajnom brusilicom u liječenju kroničnih subduralnih hematoma. Nacrt studije: Presječna studija s povijesnim podacima. Ispitanici i metode: Bolesnici s kompresijskim kroničnim subduralnim hematomima operacijski su liječeni minimalno invazivnom metodom trepanacije visokoobrtajnom brusilicom u lokalnoj anesteziji ili sedaciji. Primijenjena je minimalna incizija kože i trepanacija visokoobrtajnom brusilicom u čeonoj ili tjemenoj regiji, u području maksimalne debljine hematoma. Nakon aspiracije hematoma, silikonski kateter promjera 1,9 mm postavljen je u subduralni prostor i spojen na gravitacijsku drenažu. Bolesnici su mobilizirani neposredno po operaciji. Zabilježeni su i analizirani podaci o tijeku i uspješnosti liječenja. Rezultati: U istraživanje je uključeno 23 bolesnika (pet ženskoga spola, 21,7%). Medijan životne dobi bolesnika iznosio je 77,5 godina (interkvartilni raspon 67 – 83). Šest (26,1%) bolesnika imalo je obostrane subduralne hematome. Septirani i multilokularni hematomi opaženi su u šest (26,1%) bolesnika. Heterodenzne lezije koje odgovaraju recentnijim hematomima zabilježene su u 16 (69,5%) bolesnika. Medijan trajanja hospitalizacije iznosio je 9,5 dana (interkvartilni raspon 6 – 16). U jednoga je bolesnika zabilježen letalni ishod kao posljedica nozokomijalne infekcije i sepse. U jednoga je bolesnika zabilježena infekcija rane s razvojem subduralnoga empijema, što je zahtijevalo kraniotomiju. Jedan je bolesnik razvio duboku vensku trombozu i plućnu emboliju. U svih je bolesnika poslijeoperacijskim CT oslikavanjem zabilježena znatna redukcija volumena hematoma i pomaka središnjih mozgovnih struktura. U ovoj skupini bolesnika nisu zabilježeni epileptički napadaji nakon operacije. Zaključak: Trepanacija visokoobrtajnom brusilicom sigurna je, jednostavna i učinkovita metoda liječenja kroničnih subduralnih hematoma, uključujući multilokularne i heterodenzne lezije. Posebice je prikladna u bolesnika starije životne dobi, zbog izbjegavanja opće anestezije i dugoga trajanja operacije te kratke duljine hospitalizacijeObjectives: The objective of this study was to assess the safety and efficiency of minimally invasive high-speed drill craniostomy in the treatment of chronic subdural hematomas. Study design: The study was designed as a retrospective case series study. Patients and Methods: The patients with compressivechronic subdural hematomas were treated by minimally invasive high-speed craniostomy performed under local 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-assisted drainage. 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

Operative treatment of hydrocephalus in Osijek clinical hospital

Tijekom posljednjih 21 godinu, od početka 1978. do kraja 1998.g., izvršeno je u Osječkoj bolnici 5.286 neurokirurških operacija, od čega 321 operacija zbog hidrocefalusa (6,06%): Primjetan je porast, iz godine u godinu, broja ukupno operiranih neurokirurških bolesnika, a broj operiranih hidrocefalusa, od samo jednog u 1978. godini, do 52 u 1998. godini, reprezentativno prati ukupni porast operacija i odraz je napretka neurokirurške struke. Vremenom se mijenjala i tehnika operacije hidrocefalusa, od ugradbe Pudenzovog sistema, pa sve do "Codman-Medos Hakimove" programabilne valvule i "Bactisel Sylicon Systema". Naš je sljedeći cilj započeti endoskopske operacije u liječenju hidrocefalusa.During the last 21 years (from the beginning of 1978 till the end of 1998) 5286 neurosurgical operations were carried out at the Division of Neurosurgery of the Osijek Clinical Hospital. Among them, there were 321 operative procedures concerning hydrocephalus. The number of neurosurgical procedures was constantly increasing over the years, as well as the number of operatively treated hydrocephalus cases, which increased from only one case in 1978 to 52 in 1998. Constantly increasing number of patients who were operated on, which is significantly followed by the increase in cases with operated hydrocephalus, is a steady evidence of the improvement in neurosurgical practice. The technique of hydrocephalus operation was changing over the years as well, from the application of the Pudenz valve up to the programmable valve and bactisel system. Our immediate aim is to start implementing endoscopic surgery in the management of hydrocephalus

Operative treatment of hydrocephalus in Osijek clinical hospital

Tijekom posljednjih 21 godinu, od početka 1978. do kraja 1998.g., izvršeno je u Osječkoj bolnici 5.286 neurokirurških operacija, od čega 321 operacija zbog hidrocefalusa (6,06%): Primjetan je porast, iz godine u godinu, broja ukupno operiranih neurokirurških bolesnika, a broj operiranih hidrocefalusa, od samo jednog u 1978. godini, do 52 u 1998. godini, reprezentativno prati ukupni porast operacija i odraz je napretka neurokirurške struke. Vremenom se mijenjala i tehnika operacije hidrocefalusa, od ugradbe Pudenzovog sistema, pa sve do "Codman-Medos Hakimove" programabilne valvule i "Bactisel Sylicon Systema". Naš je sljedeći cilj započeti endoskopske operacije u liječenju hidrocefalusa.During the last 21 years (from the beginning of 1978 till the end of 1998) 5286 neurosurgical operations were carried out at the Division of Neurosurgery of the Osijek Clinical Hospital. Among them, there were 321 operative procedures concerning hydrocephalus. The number of neurosurgical procedures was constantly increasing over the years, as well as the number of operatively treated hydrocephalus cases, which increased from only one case in 1978 to 52 in 1998. Constantly increasing number of patients who were operated on, which is significantly followed by the increase in cases with operated hydrocephalus, is a steady evidence of the improvement in neurosurgical practice. The technique of hydrocephalus operation was changing over the years as well, from the application of the Pudenz valve up to the programmable valve and bactisel system. Our immediate aim is to start implementing endoscopic surgery in the management of hydrocephalus