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Neurology India
Medknow Publications on behalf of the Neurological Society of India
ISSN: 0028-3886 EISSN: 1998-4022
Vol. 51, Num. 2, 2003, pp. 291

Neurology India, Vol. 51, No. 2, April-June, 2003, pp. 291

Letter to Editor

Acute epidural hematoma following twist-drill craniostomy for chronic subdural hematoma - A rare complication

S. N. Shenoy, A. Raja
Department of Neurosurgery, Kasturba Medical College & Hospital, Manipal.

Accepted on 04.04.2002.

Code Number: ni03100


A rare complication of epidural hematoma following a twist-drill craniostomy for chronic subdural hematoma is reported.

A 45-year-old man presented with a history of headache and altered sensorium of 2 days duration. He had trivial trauma 2 months prior to admission. On examination, he was in altered sensorium and had left hemiparesis. Cranial computed tomography (CT) scan revealed right fronto-parietal chronic subdural hematoma causing compression of the ipsilateral lateral ventricle (Figure 1). Hematological investigation and coagulation profile revealed no abnormality.

A right parietal percutaneous twist-drill craniostomy was performed and closed system drainage was kept for 24 hours. The patient improved neurologically without any deficit. However, on the 4th postoperative day, he started complaining of headache which progressively increased in severity with associated diplopia. Neurological examination revealed no focal neurological deficit. A repeat CT scan revealed a large right parietal extradural hematoma with specks of pneumocephalus (Figure 2). A right parietal craniotomy and evacuation of the extradural hematoma was carried out. There was no evidence of any active bleeding. The patient improved postoperatively without any neurological deficit.

Cone first described the use of a percutaneous twist-drill craniostomy.1 Since then the twist-drill has been used for the treatment of a variety of intracranial conditions. Twist-drill craniostomy has been used both as a diagnostic procedure in head trauma and ventriculography and as a therapeutic procedure to aspirate chronic subdural hematoma, brain abscess and neoplastic cysts.1,4,7

Various surgical procedures used in chronic subdural hematoma with a variable degree of success are: burr hole with closed drainage, craniotomy, shunting of the subdural space and twist-drill craniostomy with or without closed system drainage.2-11 A variety of postoperative intracranial hematomas such as acute subdural hematoma and intracerebral hematoma, following evacuation of chronic subdural hematoma have been reported.12-15 These hemorrhagic complications are considered to be induced by rapid decompression of chronic subdural hematoma.7,9 Yoshino et al have adopted a method of gradual evacuation of chronic subdural hematoma to minimize the occurrence of these complications.4 An epidural hematoma following a twist-drill surgery has only rarely been reported.


1. Rand BO, Ward AA,White LE. The use of the twist drill to evaluate head trauma. J. Neurosurgery 1966;25:410-5.
2. Camel M. Twist-drill craniostomy for the treatment of chronic subdural hematoma. Neurosurg Clin N Am 2000;3:515-8.
3. D' Avella D, Blasi FD, Rotilio A, Pensaberu, et al. Intracerebral hematoma following evacuation of chronic subdural hematoma. J Neurosurgery 1986;65:710-2.
4. Yoshino Y, Aoki N, Oikawa A, Ohno K. Acute epidural hematoma developing during twist drill craniostomy. A complication of percutaneous subdural tapping for the treatment of chronic subdural hematoma. Surg Neurology 2000;53:601-4.
5. Kravtchouck AD, Likhterman LB, Potapov AA, E1 - Kadi H. Postoperative complication of chronic, subdural hematomas. Neurosurg Clin N Am 2000:3:547-52.
6. Yonezawa K, Kim S, Tanaka M. Acute epidural hematoma following evacuation of chronic subdural hematoma with continuous closed system drainage, No. Shinkei Geka 1992;20:1013-6 (in Japanese).
7. Hubschmann OR. Twist drill craniostomy in the treatment of chronic and sub-acute subdural hematoma in severally ill and elderly patients Neurosurgery 1980;6: 233-6.
8. Aoki N. Subdural tapping and irrigation for the treatment of chronic subdural hematoma in adults. Neurosurgery 1984;14:545-8.
9. Rychlick F, Recchioni MA, Burchianti M, et al. Percutaneous twist drill craniostomy for the treatment of chronic subdural hematoma. Acta Neurochir (Wien) 1991;113:38-41.
10. Tabaddor K, Shulman K. Definitive treatment of chronic subdural hematoma by twist drill craniostomy and closed system drainage. J Neurosurgery 1977;46:220-6.
11. Camel M, Grubb R. Treatment of chronic subdural hematoma by twist drill craniostomy with continuous catheter drainage. J Neurosurgery 1986;65:183-7.
12. Modesti LM, Hodge CJ, Barnwell ML, Intracerebral hematoma after evacuation of chronic extra cerebral fluid collections. Neurosurgery 1982;10:683-93.
13. Smely C, Madlinger A, Scherernet R. Chronic subdural Hematoma - a comparison of two different treatment modalities. Acta Neurochir (Wien) 1991;139:818-26.
14. Mckissock W, Richardson A, Bloom WH. Subdural Hematoma. A review of 389 cases. Lancet 1960;1:1365-9.
15. Harada K. Ohtsuru K, Nakayama K, Takagi S, et al. Contra lateral development at acute subdural hematoma following surgery for chronic subdural hematoma. Case report. Neural Med Chir (Tokyo) 1992;32:969-7.

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