Context: The ideal surgical treatment of chronic subdural haematoma has not been clearly defined. The choice of intervention in most centres is largely based on the personal preference of the neurosurgeon. Aims: 1. To study the neurological outcome of twist drill craniostomy in patients with chronic subdural hematoma. 2. To study the efficacy of twist drill craniostomy in chronic subdural haematoma. Settings and Design: The prospective study was conducted in a single centre, in the department of neurosurgery of a teaching hospital in South India. Methods and Material: Seventy consecutive chronic subdural haematoma patients admitted from 15January2015 to 14July2016, needing operative intervention, were subjected to twist drill craniostomy. The diagnosis was confirmed by radiological means, with significant hemispheric haematoma on imaging. Statistical analysis used: Frequencies and percentages were calculated and Friedman test was applied. Results: There was significant clinical improvement in both Markwalder grading system and Glasgow coma scale after twist drill craniostomy within 24 hours of the intervention and in the regular follow up period. There were nine deaths [12.86%] in the study group. The recurrence rate was 18.57% among the operated subjects, and could be managed mostly by aspiration through the same drill hole. Conclusions: This therapeutic approach is suitable both for elderly and for medically frail patients who pose a high anaesthetic and operative risk. The major advantage of twist drill craniostomy was that it can be performed at the patient’s bedside under local anaesthesia. The complication rate is as low as other modern surgical techniques.

Keywords: Chronic Subdural Haematoma; Twist Drill Craniostomy; Markwalder Grading System; Glasgow Coma Scale; Neurological Outcome.