AUTHOR=Wei Zeng , Jiang Haixiao , Wang Ying , Wang Cunzu 

TITLE=Effect of Twist-Drill Craniostomy With Hollow Screws for Evacuation of Chronic Subdural Hematoma: A Meta-Analysis

JOURNAL=Frontiers in Neurology

VOLUME=Volume 12 - 2021

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.811873

DOI=10.3389/fneur.2021.811873

ISSN=1664-2295

ABSTRACT=Abstract
Objective: This study systematically reviewed the clinical efficacy and safety of twist-drill craniostomy with hollow screws in chronic subdural hematoma treatment. 
Methods: A computerized search of PubMed, Embase, Web of Science, Cochrane Library, World Health Organization International Trial Registry platform, CBM, CNKI, and Wanfang Database was performed to retrieve randomized controlled trials or case-control trials using twist-drill craniostomy with hollow screws for the evacuation of chronic subdural hematoma from the date of databases’ inception to July 2021. Two investigators independently screened the studies and extracted data in strict accordance with the pre-established inclusion and exclusion criteria. RevMan 5.3 software or STATA was used for meta-analysis after evaluating the methodological quality of the included studies.
Results: A total of 4 randomized controlled trials and 16 case-control trials with a total of 2536 cases were included. Results of the meta-analysis showed that the surgical success rate and postoperative recurrence rate of twist-drill craniostomy with hollow screws were slightly higher compared to the burr hole craniostomy group, but showed no statistical significance (RR=1.03, P=0.05; RR=1.133, P=0.503>0.05). However, subgroup analysis showed that the use of YL-1 needle had a higher success rate and lower recurrence rate (RR=1.05, P=0.02<0.05; RR=0.584, P=0.002); and twist-drill craniostomy with hollow screws had a lower incidence rate of postoperative complications and postoperative acute intracranial hemorrhage compared with burr hole craniostomy, also revealing an overall shorter hospital stay (RR=0.57, P=0.0002<0.05; RR=0.584, P=0.027<0.05; WMD=-3.752, P<0.001). However, the postoperative mortality rate was practically the same between the two groups (OR=1.01, P=0.95>0.05).
Conclusion: Twist-drill craniostomy with hollow screws is not inferior or superior to burr hole craniostomy in efficacy, and this strategy is safer and minimally invasive, which is reflected in a lower incidence of acute intracranial hemorrhage, overall complication rate and length of hospital stay.