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  • A Novel Application of the Integra Camino Bolt for the Drainage the Chronic Subdural Hematoma: A Technical Note

    Final Number:
    315

    Authors:
    Ninh Doan MD PhD; Shekar N. Kurpad MD, PhD; Ha Nguyen MD; Michael Gelsomino; Saman Shabani BS, MD

    Study Design:
    Other

    Subject Category:
    Intracranial Hemorrhage/Critical Care

    Meeting: AANS/CNS Cerebrovascular Section 2016 Annual Meeting

    Introduction: Chronic subdural hematoma (CSDH) is a disease of mostly old age. The incidence is expected to increase over the next 25 years. Therefore, developing a new technique that is both simple and quick to implement while using a low cost material is highly important.

    Methods: The bolt entry point was chosen at the location with the thickest collection of CSDH. The placement of the Integra Camino bolt was in accordance with the manufacture instruction. To ensure penetration of the subdural space, the bolt was tightened until the wing of the bolt came in contact with the skin. Next, the strain relief sheath is connected to the compression cap of the bolt. The Jackson-Pratt drain is then connected to the strain relief sheath. Suction is then applied to promote drainage. The CT of the head can be performed to confirm that the bolt tip resided in the subdural space

    Results: 2 patients underwent this procedure. Patient 1 presented with bilateral chronic subdural hematoma. Patient 2 presented with a right chronic subdural hematoma coupled with a 1cm midline shift and a pontine Duret hemorrhage. This technique was effective in draining the chronic subdural hematoma in both patients. The midline shift was almost completely resolved. Both patients demonstrated significant clinical improvements. The patient has returned to work in just 2 weeks following the procedure.

    Conclusions: To combat the increasing incidence of chronic subdural hematoma, developing easy-to-do, low cost technique is highly essential. The technique described here is effective, simple to perform and can be done in a short period of time, using a device that is both low cost and readily available. Utilizing this technique, in 2 patients, has resulted in good outcomes without complications.

    Patient Care: Patients with symptomatic chronic subdural hematoma will benefit tremendously from this minimally-invasive procedure. Patients deemed to be high-risk for general anesthesia due to significant comorbidities are better suited for the bedside procedure under conscious sedation. The placement of a catheter-based subdural drain at bedside is associated with a significant complication rate of acute hematoma. We report here a method of modifying the ubiquitously available Integra Camino bolt to function as a hollow screw device for the drainage of CSDH. The technique is effective, simple to perform and can be done in a short period of time, using a low cost device.

    Learning Objectives: -A method of modifying the Integra Camino bolt to function as a hollow screw device for the drainage of chronic subdural hematoma is reported -2 patients undergoing bilateral chronic subdural hematoma drainage using Integra Camino bolts with good outcomes are described -The technique is effective, simple to perform and can be done in a short period of time, using a low cost device

    References: 1. Cenic, A., M. Bhandari, and K. Reddy, Management of chronic subdural hematoma: a national survey and literature review. Can J Neurol Sci, 2005. 32(4): p. 501-6. 2. Chari, A., et al., Twist-drill craniostomy with hollow screws for evacuation of chronic subdural hematoma. J Neurosurg, 2014. 121(1): p. 176-83. 3. Santarius, T., et al., Working toward rational and evidence-based treatment of chronic subdural hematoma. Clin Neurosurg, 2010. 57: p. 112-22. 4. Weigel, R., P. Schmiedek, and J.K. Krauss, Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry, 2003. 74(7): p. 937-43. 5. Tabaddor, K. and K. Shulmon, Definitive treatment of chronic subdural hematoma by twist-drill craniostomy and closed-system drainage. J Neurosurg, 1977. 46(2): p. 220-6. 6. Ducruet, A.F., et al., The surgical management of chronic subdural hematoma. Neurosurg Rev, 2012. 35(2): p. 155-69; discussion 169. 7. Asfora, W.T. and L. Schwebach, A modified technique to treat chronic and subacute subdural hematoma: technical note. Surg Neurol, 2003. 59(4): p. 329-32; discussion 332. 8. Emonds, N. and W.E. Hassler, New device to treat chronic subdural hematoma--hollow screw. Neurol Res, 1999. 21(1): p. 77-8. 9. Safain, M., et al., A single center's experience with the bedside subdural evacuating port system: a useful alternative to traditional methods for chronic subdural hematoma evacuation. J Neurosurg, 2013. 118(3): p. 694-700. 10. Rughani, A.I., et al., A case-comparison study of the subdural evacuating port system in treating chronic subdural hematomas. J Neurosurg, 2010. 113(3): p. 609-14. 11. Balser, D., et al., Evolving management of symptomatic chronic subdural hematoma: experience of a single institution and review of the literature. Neurol Res, 2013. 35(3): p. 233-42.

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