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

Kawasaki, Toshinari; Kurosaki, Yoshitaka; Fukuda, Hitoshi; Kinosada, Masanori; Ishibashi, Ryota; Handa, Akihiro; Chin, Masaki; Yamagata, Sen

doi:10.1007/s00701-017-3399-2

Cited by 30 publications

(24 citation statements)

References 14 publications

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“…Previous reports also stated that older patients appear to be good candidates for endoscopic evacuation. 9,17 An endoscopic approach may also be preferable in patients who cannot tolerate a larger craniotomy because of blood loss or other comorbidities or who could benefit from a shorter surgery. Patients with an enlarging SDH and associated brain contusions, who were excluded by Yokosuka et al, 9 may be eligible for the technique as long as bipolar cautery is available.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic Treatment of Acute Subdural Hematoma with a Normal Small Craniotomy

Hwang

Shin

2019

J Neurol Surg A Cent Eur Neurosurg

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Background Endoscopic surgery is helpful in evacuating intracranial hematomas. However, the indication and the craniotomy location are still unclear in the endoscopic evacuation of acute subdural hematomas (SDHs). This study evaluated the feasibility and efficacy of endoscopic treatment of acute SDH via a normal small craniotomy. Methods A normal small craniotomy (∼ 3 × 4 cm) as a surgical window was made at the superior temporal line around the coronal suture on the lesion side. A 4-mm rigid endoscope with a 0-degree lens was introduced into the subdural space, and the hematoma was evacuated using irrigation and suction devices with various angles. Endoscopic surgery was performed in 13 older adult patients with acute SDH. Adequacy of the hematoma evacuation, bleeding control, and clinical outcomes were analyzed. Results The mean age of the patient was 78.6 years (range: 65–89 years). Four cases of cortical arterial bleeding were encountered and controlled with bipolar cauterization. No re-bleeding was observed postoperatively in any patient. Near-total hematoma removal was achieved. Remnant hematoma was scanty and located in the parietal area. No further craniectomy was required after the endoscopic surgery. The outcome at discharge was closely related to the patient's level of consciousness before the operation. Conclusion A small craniotomy around the superior temporal line provides an optimal window to evacuate an acute SDH and achieve hemostasis using an endoscope. Endoscopic evacuation of acute SDHs could be effective in selected cases.

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Section: Discussionmentioning

confidence: 99%

“…Flexible endoscopes were used to treat traumatic intracranial hemorrhages in the 1990s. 19 Recently, Kawasaki et al 17 reported application of a flexible endoscope for the evacuation of acute and subacute SDHs. One surgeon navigated the 5-mm flexible endoscope while a second surgeon removed the hematoma.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Treatment of Acute Subdural Hematoma with a Normal Small Craniotomy

Hwang

Shin

2019

J Neurol Surg A Cent Eur Neurosurg

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“…It provides good visualization compared with the flexible scope. There are reports of use of both rigid [1][2][3][4]8,10,[12][13][14]17,19,21 and flexible scopes 5,9,11 in the management of CSDH. There may be difficulty in advancing the rigid scope, especially when the bony opening is not selected properly.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Management of Chronic Subdural Hematoma

Yadav

Ratre

Parihar

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Background Twist drill evacuation, burr hole aspiration, mini-craniotomy, and craniotomy are some of the surgical methods to remove chronic subdural hematoma (CSDH). Endoscopic treatment was also recently found to be useful. Methods We conducted a prospective study of 72 hematomas in 68 patients. Computed tomography was performed in all cases. Endoscopic surgery was performed in all CSDH patients. Surgical procedure A 4-cm skin incision was performed at the most curved part of skull with the CSDH. A mini-craniotomy or enlarged burr hole was made. The inner and outer table of the burr hole margin was drilled to provide a straight trajectory to the hematoma cavity. An endoscope supported by a telescope holder was used. A modified silicone brain retractor was used in five patients. A subgaleal drain was left in all patients for 3 to 5 days. Results There were 42 male and 26 female patients. The age ranged from 45 to 79 years (average: 69 years). All patients had a history of head trauma. Preoperative average Glasgow Coma Scale Score was 14. The procedure was effective in hematoma evacuation and a good visualization of the whole cavity in all patients. The endoscopic technique helped in complete hematoma removal in organized/solid clot, septations, and bridging vessels in 17, 2, and 2 cases, respectively. Duration of surgery ranged from 35 to 80 minutes. One death occurred. There was no recurrence, infection, fresh bleed, or injury to the brain or membrane. Conclusion The endoscopic technique is an effective alternative technique for treating CSDH. Although the study has limitations because of the small number of patients with a short follow-up, the study indicated that thick and vascular membranes, septations, and organized and solid clots can be removed effectively using this technique.

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“… 14 36) And endoscopic removal of ASDH have been reported recently. 19 41 51 56 100) But, no well-designed comparative study or large case series is reported and clinical experiences are limited up to now. And also, indications for the endoscopic surgery have not been well established.…”

Section: Surgical Management Of Asdhmentioning

confidence: 99%

“…Flexible endoscope, even in low resolution, can be a good tool to get optimal and safe evacuation of the ASDH. 51) Endoscopic evacuation of traumatic ASDH will be a novel procedure as a minimally invasive surgery in appropriately selected cases.…”

Section: Surgical Management Of Asdhmentioning

confidence: 99%

Neurocritical Management of Traumatic Acute Subdural Hematomas

Shin

Hwang

2020

Korean J Neurotrauma

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Acute subdural hematoma (ASDH) has been a major part of traumatic brain injury. Intracranial hypertension may be followed by ASDH and brain edema. Regardless of the complicated pathophysiology of ASDH, the extent of primary brain injury underlying the ASDH is the most important factor affecting outcome. Ongoing intracranial pressure (ICP) increasing lead to cerebral perfusion pressure (CPP) decrease and cerebral blood flow (CBF) decreasing occurred by CPP decrease. In additionally, disruption of cerebral autoregulation, vasospasm, decreasing of metabolic demand may lead to CBF decreasing. Various protocols for ICP lowering were introduced in neuro-trauma field. Usage of anti-epileptic drugs (AEDs) for ASDH patients have controversy. AEDs may reduce the risk of early seizure (<7 days), but, does not for late-onset epilepsy. Usage of anticoagulants/antiplatelets is increasing due to life-long medical disease conditions in aging populations. It makes a difficulty to decide the proper management. Tranexamic acid may use to reducing bleeding and reduce ASDH related death rate. Decompressive craniectomy for ASDH can reduce patient's death rate. However, it may be accompanied with surgical risks due to big operation and additional cranioplasty afterwards. If the craniotomy is a sufficient management for the ASDH, endoscopic surgery will be good alternative to a conventional larger craniotomy to evacuate the hematoma. The management plan for the ASDH should be individualized based on age, neurologic status, radiologic findings, and the patient's conditions.

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

Abstract: 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.

Cited by 30 publications

References 14 publications

Endoscopic Treatment of Acute Subdural Hematoma with a Normal Small Craniotomy

Endoscopic Treatment of Acute Subdural Hematoma with a Normal Small Craniotomy

Endoscopic Management of Chronic Subdural Hematoma

Neurocritical Management of Traumatic Acute Subdural Hematomas

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