A Systematic Review Comparing Burr-Hole Craniostomy and Twist-Drill Craniostomy for the Treatment of Chronic Subdural Hematoma

Abstract

Background: Chronic subdural hematoma (CSDH) is one of the most prevalent neurological conditions in the elderly population. However, the ideal surgical approach for its treatment remains a matter of debate. This study aims to compare the safety and effectiveness of three surgical techniques: single burr-hole craniotomy (sBHC), double burr-hole craniostomy (dBHC), and twist-drill craniostomy (TDC) in patients with CSDH. Methods: Following PRISMA 2020 guidelines, this systematic review focused exclusively on full-text articles published in English between 2014 and 2024. Result: The study conducted a comprehensive review of over 300 publications sourced from reputable databases, including ScienceDirect, SagePub, and PubMed. Following an initial screening, five publications were identified as warranting more in-depth analysis. Consequently, a thorough review of these selected studies was performed to ensure a detailed and rigorous evaluation. Conclusion: Double burr-hole craniotomy (dBHC) appears to be the most favorable surgical technique for managing CSDH, showing lower recurrence and reoperation rates compared to twist-drill craniotomy (TDC). However, dBHC demonstrated no significant advantage over sBHC and TDC in terms of complications, mortality, cure rates, or hospitalization duration.