Endoscope-Assisted Evacuation of Acute-on-Chronic Subdural Hematomas: A Single-Center Series

Abstract

Purpose: Acute subdural hematomas are frequent, highly morbid, and affect all age groups. The most common mechanism of injury is a low-velocity fall, and the incidence of the disease is growing due to increasingly aggressive antithrombotic and anticoagulant therapies. In this study, we aimed to share our experience with the endoscopic-assisted evacuation of acute subdural hematoma, a less invasive procedure compared to standard craniotomy.Methods: We retrospectively reviewed data of all consecutive patients aged 18 years and older who underwent endoscopic-assisted evacuation of acute-on-chronic subdural hematoma at our institution from 2015 to 2019. Preoperative, intraoperative, postoperative, and follow-up data were collected and reported. Statistical tests were done using Python statistical packages.Results: Of the 35 patients that underwent this procedure, 32 were 18 years and older. The median age was 69.5 years and 37.5% were female. Twenty patients (62.5%) were on antiplatelet therapy, and six patients (18.75%) were on anticoagulants upon presentation. A fall was the most common cause of trauma (71.88%). The median operative time was 107 minutes. The median length of stay in days and Glasgow Coma Scale (GCS) at discharge were 8.5 and 15, respectively. There were no surgical site infections or in-hospital mortality in this series. At the latest follow-up, the median GCS and modified Rankin Scale were 15 and 1, respectively.Conclusion: Evacuation of acute-on-chronic subdural hematomas can be performed safely and efficiently via a smaller craniotomy and with the assistance of an endoscope. This may represent a less invasive alternative than standard craniotomy/craniectomy in selected patients.

Endoscopic evacuation of chronic subdural hematoma with rigid and flexible endoscope: case report

“…However, this technique should not be the first choice for treating acute subdural haematomas caused by high-velocity trauma in patients with a low Glasgow Coma Scale 9 . For such patients, decompressive craniectomy and subdural haematoma evacuation should be the standard procedure 9 .…”

“…However, this technique should not be the first choice for treating acute subdural haematomas caused by high-velocity trauma in patients with a low Glasgow Coma Scale 9 . For such patients, decompressive craniectomy and subdural haematoma evacuation should be the standard procedure 9 . Further studies on a larger patient group of different ages with different time duration of haematoma should confirm the superiority of the endoscopic procedure over conventional methods.…”

Mini-Perforated Craniotomy with Subperiosteal Drainage

“…The endoscopic technique of CSDH evacuation is an alternate technique that allows the excision of thick membranes, cutting of septa, and the ability to suck out even solid/semisolid clots. 6,7 The mini-craniotomy site in the endoscopic technique is at the most anterior/posterior, lateral and curving part of the hematoma to allow direct and complete access using an endoscope. The procedure is performed under direct endoscopic vision and thus all variations in the CSDH can be safely and effectively dealt with.…”