Neurosurg Focus 59(4):E2, 2025
A randomized trial compared hollow screw (HS) trephination under local anesthesia to enlarged burr hole (BH) trepanation under general anesthesia for chronic subdural hematoma. HS showed similar recurrence and clinical outcomes, but with shorter operation time, hospital stay, and lower costs, supporting its use in older, comorbid patients.
• A randomized clinical trial compared hollow screw (HS) trephination under local anesthesia to enlarged burr hole (BH) craniotomy under general anesthesia for chronic subdural hematoma (cSDH) evacuation.
• 131 patients (mean age 77) were analyzed; both groups were similar in demographics and risk factors.
• HS had a higher, but not statistically significant, recurrence rate compared to BH (HS 47.8% vs BH 31.2%, p = 0.06).
• Clinical outcomes and complication rates were equivalent between HS and BH groups.
• HS procedures were significantly less invasive, with shorter operation times (median 21 vs 33.5 minutes) and shorter hospital stays (median 3.0 vs 4.3 days).
• HS treatment was less costly than BH (806 vs 1884.70 euros per case, excluding infrastructure).
• HS trephination is a reasonable alternative to BH, especially for elderly or multimorbid patients, given similar outcomes and improved efficiency.
• Study limitations include single-center design, limited sample size, and lack of blinding.
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