OBJECTIVE Chronic subdural hematoma (CSDH) is an important health problem observed mostly in elderly population. Here, we aimed to describe and validate a simple modified technique of twist-drill craniostomy (TDC) using easily accessible tools for effective and safe bedside CSDH drainage. METHODS A detailed description of the new modified TDC technique which allows for sequential drainage and irrigation under physiological conditions is provided. Clinical and radiological characteristics as well as surgical results of the patients undergoing this procedure are also presented. RESULTS A total of 55 patients (30 M, 25 F) underwent this modified TDC. Mean age was 61.7 ± 12.3 years. Medical comorbidities were common (76.4 %). Subdural hematoma was mostly unilateral (83.6 %). Maximum width of hematoma was 21 ± 4 mm on average (range: 9-38 mm). In total, patients underwent 1.6 ± 0.9 subdural tappings on average (median: 1, range: 1-5). Repeat tappings were performed in 43.6 % of the patients. No mortality, serious morbidity or infectious complications were noted. Pneumocephalus was either absent or minimal in most cases (96.4 %). Mean length of hospital stay was 4.9 ± 4.0 days (median: 3; range: 2-20 days). The clinical outcomes were favorable in 92.7 % of the patients (no craniotomy required and no symptomatic recurrence detected). CONCLUSION This modified technique of TDC utilizes easily available tools, yields satisfactory radiological and clinical results, allows repeated tappings even in outpatient settings and can thus be readily applied in every neurosurgical unit across the world. It can be an effective alternative to existing procedures for patients with multiple co-morbidities and/or high anesthesia risk, in emergency conditions and busy neurosurgical centers.

中文翻译：

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一种简单有效的改良麻花钻开颅术用于慢性硬膜下血肿床旁引流冲洗的技术和临床研究

目的 慢性硬膜下血肿 (CSDH) 是一个重要的健康问题，主要见于老年人群。在这里，我们旨在描述和验证一种简单的螺旋钻开颅术 (TDC) 改良技术，使用易于访问的工具进行有效和安全的床边 CSDH 引流。方法 提供了新的改良 TDC 技术的详细描述，该技术允许在生理条件下进行顺序排水和灌溉。还介绍了接受该手术的患者的临床和放射学特征以及手术结果。结果 共有 55 名患者（30 M，25 F）接受了这种改良的 TDC。平均年龄为 61.7 ± 12.3 岁。内科合并症很常见（76.4%）。硬膜下血肿多为单侧（83.6%）。血肿的最大宽度平均为 21 ± 4 mm（范围：9-38 mm）。总共，患者平均接受了 1.6 ± 0.9 次硬膜下敲击（中位数：1，范围：1-5）。43.6% 的患者进行了重复敲击。没有发现死亡、严重的发病率或感染性并发症。在大多数情况下（96.4%），气脑不存在或很少。平均住院时间为 4.9 ± 4.0 天（中位数：3；范围：2-20 天）。92.7% 的患者临床结果良好（无需开颅手术且未检测到症状性复发）。结论 这种改良的 TDC 技术利用容易获得的工具，产生令人满意的放射学和临床结果，即使在门诊环境中也允许重复敲击，因此可以很容易地应用于世界各地的每个神经外科单位。