Evacuation of subdural collections by endoscopy

Abstract

Our aim was to explore the theory that minimally invasive inspection of haematoma cavities is conceivable and might conceivably improve the remedial mediation of burr-hole drainage in chronic SDH. endoscope-assisted drainage technique with mini-craniotomy was used in a 24-month period, and the prospectively collected data of 8 patients was reviewed. █ mATERIAl and mEThODSOver 24 months, total of 10 procedures (8 patients) were performed with mini-craniotomy and endoscopic assistance. The indications for mini-craniotomy surgery are beyond the scope of this article. Six patients had one operation and they were operated on one side, and two patients had two operations and they were operated on at different times and sides. Consent was obtained from the patients. █ INTRODUCTION T wist drill craniostomy, burr-hole craniostomy, and minicraniotomy or craniotomy are major methods to locate chronic subdural haematoma (SDH) (8). All of them have different morbidity, mortality, recurrence and cure rates (8,16). Twist drill and burr-hole craniostomy are the first line surgical techniques, though craniotomy is usually preferred as a second line method (8).During the past 20 years, the general postoperative result of surgical treatment for chronic SDH has not enhanced considerably (2). Present studies only focus on the use of endoscopy for the evacuation of SDH. The use of intracranial endoscopy in neurotraumatology was initially considered as a specialized technique in 1980s (6).AIm: Intraoperative use of the endoscope is a hot topic in neurosurgery and it gives broader visualization of critical and hardlyreached areas. endoscope-assisted surgical approach to chronic subdural haematoma (SDH) is a minimally invasive technique and may give an expansion to the regular method of burr-hole haematoma drainage. mATERIAl and mEThODS: endoscope-assisted haematoma drainage with mini-craniotomy was performed over a 24-month period, and prospectively collected data is reviewed. A total of 10 procedures (8 patients) were performed using the endoscopeassisted technique. Four of them were chronic SDH and six were subacute SDH. RESUlTS:Procedures were extended 20 minutes in average because of endoscopic intervention. There was no extra-morbidity through the study as a consequence of endoscopic assessment.CONClUSION: endoscope-assisted techniques can make the operation safe in selected circumstances with improved intraoperative visualization. It may likewise take into consideration the identification and destruction of neo-membranes, septums and solid clots. In addition, the source of bleeding can be easily coagulated. The endoscope-assisted techniques, with all of these features, can alter the pre-and intra-operative decision-making for selected patients.

<p>Evacuation of chronic and subacute subdural hematoma via transcranial neuroendoscopic approach</p>

“…The technique of neuroendoscopic hematoma removal had been discussed extensively in the literature and was first introduced to SCSDH in 1988 4. It was found that endoscope-assisted techniques did not increase morbidity, and with improved intraoperative visualization, it could help identify and destruct neomembranes, septums, and solid clots and coagulate the source of bleeding, which made this approach more safe and effective for the treatment of CSDH 7. Májovský et al found that a flexible endoscope-assisted evacuation for CSDH permitted decent visualization of the hematoma cavity and retained the advantages of a minimally invasive approach.…”

“…Recently, minimally invasive surgery with a neuroendoscope for CSDH and SASDH has been successfully demonstrated 4,7,8. This technique may provide broader visualization and the chance to separate the membrane of the intra-hematoma cavity to reduce the recurrence rate,9 which makes it a promising method for the treatment of CSDH and SASDH.…”