Comparison of an Electrical Cranial Access Drill With Autostop Technology to a Traditional Hand Crank Cranial Access Drill.

Abstract

Background and objectives: Craniostomies performed at bedside are one of the most important procedures in neurosurgery allowing for cranial access for monitoring of intracranial pressure, evacuation of subdural or epidural hematomas, or the placement of external ventricular drains. Although neurosurgery as a whole has seen rapid advances in its technology, craniostomies continue to be performed with hand crank drill technology similar to what was used in the 1600s. The purpose of this study was to compare the efficacy and safety profile of a novel electrical cranial access drill with autostop technology (ECAD) to that of traditional hand crank drills.

Methods: Using both drills, holes were drilled into the cranial vault of human cadavers by a veteran cranial surgeon and by a medical student without prior experience in the procedure. Time to drill each hole and the number of dural violations was compared between drills.

Results: Overall, 30 craniostomies were created with the hand crank drill and 61 were created with the ECAD. The average time to hole competition was significantly longer with the hand crank drill than with the ECAD (24.1 vs 16.5 seconds, P < .001). There were significantly more dural violations with the hand crank drill than with the ECAD (13 vs 2, P = .002), which engaged autostop in 100% of procedures.

Conclusion: The electric drill with autostop technology demonstrated faster time to hole completion and significantly fewer dural violations than the traditional hand crank drill.