{
  "abstract": "Introduction\n\nRecurrence remains challenging in chronic subdural hematoma (cSDH). Twist-drill craniostomy (TDC) permits bedside treatment, but incomplete evacuation limits its effectiveness in membranous hematomas. Thus, we introduced TDC with pressure-controlled fibrinolytic irrigation therapy (TDC-FIT).Research question\n\nWithin an institutional risk-adapted treatment algorithm, how does the reoperation risk compare after TDC-FIT versus TDC?Material and methods\n\nAll patients undergoing cSDH surgery in 2025 were included. TDC-FIT was preferentially used for recurrent and/or membranous cSDH. The primary outcome was ipsilateral recurrent/persistent cSDH requiring surgery <3 months. Procedure-level analyses used robust patient-clustered standard errors, and patient-level sensitivity analyses.Results\n\n208 procedures were performed in 139 patients; 191 procedures in 130 patients were eligible for the primary analysis. Reoperation occurred after 2/39 TDC-FIT (5.1%) and 35/152 TDC procedures (23.0%; RR 0.22, 95% CI 0.05-0.93; P = 0.040), an absolute risk difference of -17.9 percentage points. The adjusted RR was 0.16 (95% CI 0.03-0.74; P = 0.020). Patient-level RRs were 0.25 for index surgery, 0.15 for first recurrent or persistent episode, and 0.17 for membranous configurations; estimates were imprecise. Procedure-related complications occurred after 6/43 TDC-FIT procedures and 12/165 TDC procedures (RR 1.92, 95% CI 0.75-4.91; P = 0.174).Conclusion and discussion\n\nWithin this risk-adapted algorithm, TDC-FIT was associated with fewer reoperations, despite preferential use in higher-risk cSDH. Patient-level estimates were directionally consistent but imprecise. Complications were numerically more frequent after TDC-FIT, and equivalent safety cannot be inferred. Randomized studies are needed to establish effectiveness and safety.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.",
    "Department of Neurosurgery, Ruhr-University Bochum, Universitaetsklinikum Knappschaftskrankenhaus Bochum GmbH, Bochum, Germany.",
    "Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Roberto Doria-Medina"
    },
    {
      "affs": [
        0
      ],
      "name": "Marco Bissolo"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "István Csók"
    },
    {
      "affs": [
        2
      ],
      "name": "Lucas Becker"
    },
    {
      "affs": [
        0
      ],
      "name": "Manou Overstijns"
    },
    {
      "affs": [
        0
      ],
      "name": "Mazin Omer"
    },
    {
      "affs": [
        0
      ],
      "name": "Mukesch Johannes Shah"
    },
    {
      "affs": [
        0
      ],
      "name": "Jürgen Beck"
    },
    {
      "affs": [
        0
      ],
      "name": "Roland Roelz"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/bw08eykggjjym.bib",
  "cited_by": 0,
  "doi": "10.1016/j.bas.2026.107487",
  "fulltext_url": "https://europepmc.org/articles/PMC13718344",
  "id": "bw08eykggjjym",
  "issns": [
    "2772-5294"
  ],
  "landing_url": "https://europepmc.org/article/MED/42960131",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Article"
    ],
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      "openalex",
      "2728|Neurosurgical Procedures and Complications"
    ]
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  "openalex": "W7223082217",
  "pdf_url": "https://europepmc.org/articles/PMC13718344?pdf=render",
  "pmcid": "PMC13718344",
  "pmid": "42960131",
  "published": "2026-10-21",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/bw08eykggjjym.ris",
  "sources": [
    {
      "first_seen": "2026-11-01T00:20:50Z",
      "native_id": "MED:42960131",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42960131"
    },
    {
      "first_seen": "2026-11-02T12:22:23Z",
      "native_id": "PMC13718344",
      "source": "pmc",
      "url": "https://doi.org/10.1016/j.bas.2026.107487"
    }
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2728|Neurosurgical Procedures and Complications",
      "subfield": "neurology"
    }
  ],
  "title": "Higher risk, lower recurrence: A year of risk-adapted twist-drill craniostomy with pressure-controlled fibrinolytic irrigation therapy for chronic subdural hematoma.",
  "title_text": "Higher risk, lower recurrence: A year of risk-adapted twist-drill craniostomy with pressure-controlled fibrinolytic irrigation therapy for chronic subdural hematoma.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-02T12:22:23Z",
  "url": "https://research.draconitic.com/paper/bw08eykggjjym",
  "venue": "Brain & spine",
  "versions": []
}