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.
E-mail: shenoysn@yahoo.com

Accepted on 04.04.2002.

Code Number: ni03100

Sir,

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 4^th 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.

REFERENCES

1. Rand BO, Ward AA,White LE. The use of the twist drill to evaluate head trauma. J. Neurosurgery 1966;25:410-5.
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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.
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