Flexible endoscopically assisted evacuation of acute and subacute subdural hematoma through a small craniotomy: preliminary results

• Published in: Acta neurochirurgica Vol. 160; no. 2; pp. 241 - 248
• Main Authors: Kawasaki, Toshinari, Kurosaki, Yoshitaka, Fukuda, Hitoshi, Kinosada, Masanori, Ishibashi, Ryota, Handa, Akira, Chin, Masaki, Yamagata, Sen
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.02.2018; Springer Nature B.V
• Subjects: Anesthesia; Blood; Brain; Coma; Complications; Dura mater; Geriatrics; Hematoma; Hemorrhage; Interventional Radiology; Local anesthesia; Medicine; Medicine & Public Health; Meninges; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Older people; Patients; Statistical analysis; Suction; Surgical Orthopedics; Technical Note - Neurosurgical Techniques; Evacuation; Local anesthesia; Endoscope; Acute subdural hematoma
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-017-3399-2

Background The first choice to treat acute subdural hematoma (SDH) is a large craniotomy under general anesthesia. However, increasing age or comorbid burden of the patients may render invasive treatment strategy inappropriate. These medically frail patients with SDH may benefit from a combination of small craniotomy and endoscopic hematoma removal, which is less invasive and even available under local anesthesia. Although hematoma evacuation with a rigid endoscope for acute or subacute SDHs has been reported in the literature, use of a flexible endoscope may have distinct advantages. In this article, we attempted to clarify the utility of small craniotomy evacuation with a flexible endoscope for acute and subacute SDH in the elderly patients. Method Between November 2013 and September 2016, a total of 17 patients with acute SDH (15 patients), subacute SDH (1 patient), or acute aggravation of chronic SDH (1 patient) underwent hematoma evacuation with a flexible endoscope at our hospital and were enrolled in this retrospective study. Either under local or general anesthesia, the SDH was removed with a flexible suction tube with the aid of the flexible endoscope through the small craniotomy (3 × 4 cm). Hematoma evacuation rate, improvement of clinical symptoms, and procedure-related complications were evaluated. Results Hematoma evacuation rate was satisfactory, and statistically significant clinical improvement was observed in postoperative Glasgow Coma Scale in all cases compared to the preoperative assessment. No procedure-related hemorrhagic complications were observed. Conclusions The results reported here suggest that small craniotomy evacuation with a flexible endoscope is a safe, effective, and minimally invasive treatment for acute and subacute SDH in selected cases.