Utility and Efficacy of a Rigid Endoscope for Recurrent Huge Chronic Subdural Hematoma

Abstract

An 83-year-old male patient was admitted to our hospital due to consciousness disturbance. Computed tomography demonstrated a huge chronic subdural hematoma on the left side. The thickness was 4 cm, and the cingulate gyrus was herniated to the right side. Blood examination showed that prothrombin time and activated partial thromboplastin time were normal. Bleeding time was slightly prolonged at 3 minutes 30 seconds. Emergency surgery was performed on admission. Three weeks after the first surgery, the patient became progressively drowsy and feeding was slow. Repeated computed tomographic scans demonstrated recurrence. At the second surgery, we used the 70-degree rigid endoscope (Storz, Germany) to obtain a direct view of the clot and bleeding site. We removed the clot and washed out the cavity with saline. Six months after the second surgery, there has not been any recurrence of the chronic subdural hematoma. In Japan, many aged patients with ischemic heart disease or cerebral infarction have been treated with anticoagulative agent and/or antithrombotic agent. We need to carefully monitor patients receiving antithrombotic therapy or anticoagulation therapy. Special training in the care of such patients is needed for support staff to prevent falls. For aged patients, minimally invasive surgery such as endoscopeassisted surgery may be effective for thick or intractable chronic subdural hematoma.