Efficacy analysis of flexible neuroendoscopy combined with dry-field techniques in the treatment of chronic subdural hematoma

Guan, Feng; Peng, Weicheng; Huang, Hui; Dai, Bin; Zhu, Guangtong; Xiao, Zhiyong; Mao, Beibei; Yang, Lin; Zhou, Quan; Wei, Yaping; Hu, Zhiqiang

doi:10.1097/cm9.0000000000000249

Cited by 10 publications

(5 citation statements)

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“…Our study found that the hematoma recurrence rate at the 6 month followup was 4.4% in the INET group, which was significantly lower than that in the control group. The latest report of recurrence rate using soft neuroendoscopic techniques to treat chronic subdural hematoma was 5.33% during 0.5-8 years of follow-up, which was similar to ours (31). All the recurrent cases were patients with bilateral subacute-chronic mixed subdural hematomas.…”

Section: Discussionsupporting

confidence: 86%

A Clinical Study of the Intra-Neuroendoscopic Technique for the Treatment of Subacute-Chronic and Chronic Septal Subdural Hematoma

et al. 2020

Front. Neurol.

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The surgical technique, safety, efficacy, and clinical application value of the intra-neuroendoscopic technique (INET) for the treatment of subacute-chronic and chronic septal subdural hematoma was investigated based on the structure and pathological features of the hematoma wall, and the critical factors of hematoma growth and recurrence were determined, in order to provide reference for clinical drug treatment. Methods: This was non-randomized concurrent control study. A total of 94 patients who met the inclusion criteria were recruited between May 2015 and February 2019 and were divided into the INET treatment group (INET group, 45 cases) and the burr hole drainage (BHD) treatment group (control group, 49 cases). The hematoma fluid components and the morphological structure and pathological characteristics of the hematoma wall were analyzed, and the surgical duration, subdural drainage tube (SDT) placement duration, intracranial infection rate, Bender grade at the 1 month post-operative follow-up and hematoma recurrence rate within the 6 months of post-operative follow-up were compared between the two groups. A multiple logistic regression model was established to analyze the risk factors associated with recurrence within 6 months. Results: Intraoperative endoscopy showed that the adhesion bands that formed early in the hematoma cavity were strip-like and that those that formed late were lock-column-like. The hematoma cavity was divided into different-sized chambers with by these strips/columns. Pathological sections of cyst wall reveled angiogenesis inside the cyst and mucus-like changes, rupture and hemorrhage in the vascular wall. Obvious inflammatory cell infiltration and fibrous connective tissue hyperplasia were observed in the cyst wall. The osmotic pressure of the hematoma fluid was not significantly different from that of the peripheral venous blood [(296.7 ± 10.3) mOsm/kg vs. Du et al. Intra-Neuroendoscopic Technique for Subdural Hematoma (291.5 ± 12.4) mOsm/kg, p = 0.68]. However, the D-dimer contents which reflect the severity of fibrinolysis in the hematoma and the proinflammatory cytokine interleukin 6 (IL-6) were significantly higher in the hematoma fluid than in the peripheral venous blood. The surgery duration for the INET group was significantly longer than that for the control group [(60.4 ± 10.6) min vs. (44.1 ± 9.8) min, p = 0.00], but both the hematoma recurrence rate within 6 months of post-operative follow-up (4.4 vs. 24.5%, p = 0.00) and the SDT placement duration [(2.1 ± 0.6) d vs. (3.9 ± 0.7) d, p = 0.00] for the INET group were both lower than those for the control group. The intracranial infection rate did not differ significantly between the two groups (4.4 vs. 10.2%, p = 0.50). The overall effective rate of the Bender grade at 1 month of follow-up did not differ significantly between the two groups (95.6 vs. 87.8%, p = 0.32), but the proportion of patients who recovered to Bender grade 0 with no symptoms was significantly higher in the INET group than in the control group (86.7 v...

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Section: Discussionsupporting

confidence: 86%

A Clinical Study of the Intra-Neuroendoscopic Technique for the Treatment of Subacute-Chronic and Chronic Septal Subdural Hematoma

et al. 2020

Front. Neurol.

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“…In the double-nostril approach, when two medical personnel perform the surgery, the operation space can be increased, and the cooperation and coordination during the operation can be improved, which can greatly enhance the operation efficiency. Zeng et al ( 40 , 41 ) reported that both single and dual-nostril approaches are effective in removing pituitary adenomas, and they found no significant difference in operation time and postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Clinical study on the selection of endoscopes and microscopes for transsphenoidal surgery of non-aggressive pituitary macroadenoma and microadenoma and the influencing factors of hyposmia after endoscopic transsphenoidal surgery

Kong,

Cheng,

Zhan

2024

Front. Neurol.

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Background and objectiveTranssphenoidal surgery, including endoscopic and microscopic resection, is the first choice of treatment for pituitary tumors. With the widespread application of neuroendoscopy in recent decades, there has been a trend to replace microscopes. In clinical practice, we have found that in transsphenoidal surgery for non-invasive microadenomas and macroadenomas, microscopy can achieve a higher total resection rate, shorter operation time, lower incidence of postoperative complications, and faster recovery of olfaction. This study aimed to explore the selection of endoscopes and microscopes for non-aggressive transsphenoidal surgery for pituitary adenomas and the factors affecting olfactory recovery.MethodsFrom August 2019 to October 2022, 93 patients with non-aggressive microadenomas and macroadenomas via the transsphenoidal approach were selected from the First Affiliated Hospital of Harbin Medical University and treated with rich experience in pituitary tumor subspecialty microscopy and endoscopic surgery. Different surgical methods were used to divide the patients into microscopic (n = 35) and endoscopic (n = 58) groups. The total tumor removal rate, intraoperative blood loss, operation time and cost, postoperative hospital stay, recovery of visual function, postoperative changes in hormone levels, complication rate, and recovery from complications 3 months after the operation were compared between the two groups.ResultsThere were no significant differences in the tumor removal rate, postoperative visual acuity, and visual field recovery between the two groups (p > 0.05). There was a significant difference in the recovery rate of olfactory function between the two groups 3 months after the operation (p < 0.05), and there was no significant difference in the incidence of other complications (p > 0.05); Compared with the two groups, the microscope group had shorter operation time, longer postoperative hospital stay, less average operation cost and less blood loss, and the difference was statistically significant (p < 0.05). The position of the nasal septum mucosal flap incision was a risk factor for hyposmia 3 months after the operation.ConclusionMicrosurgery and endoscopic surgery are suitable surgical treatments for nonaggressive microadenomas and macroadenomas. The total tumor removal and postoperative hormone remission rates of the two surgical methods were approximately the same. However, the microsurgery group had a shorter operation time, less intraoperative blood loss, faster olfactory function recovery, and a lower average operation cost. The position of the nasal septal mucosal flap incision was a risk factor for hyposmia at 3 months postoperatively. Hyposmia is less likely to occur when the superior edge of the nasal septal mucosal flap incision is not higher than the lower edge of the ipsilateral superior turbinate.

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“…Relevant medical studies have shown that neuroendoscopy-assisted surgery has good effect and high reliability and safety in the treatment of septated CSDH and can be the preferred clinical procedure. [14][15][16] In this study, 48 patients underwent neuroendoscopyassisted surgery. The liquefied hematoma flowed out after opening the dura mater and wall envelope intraoperatively, and the neuroendoscopic exploration revealed that the residual blood clots in the hematoma cavity were deposited in the visceral envelope or in the interstitial space at the envelope reflection, which could be easily removed by suction.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and prognosis of neuroendoscopy-assisted surgery for chronic subdural hematoma

Ma¹,

Song²,

Lin

2023

Pak J Med Sci

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Objective: This paper aims to analyze the clinical effect and prognosis of neuroendoscopy-assisted surgery for chronic subdural hematoma (CSDH). Methods: The clinical data of CSDH patients who underwent surgery between March 2018 and June 2020 in the Department of Neurosurgery of the First Affiliated Hospital of Xiamen University were retrospectively collected and analyzed. Eighty patients with CSDH who met the inclusive criteria were selected. A control group (32 cases treated with burr hole drainage) and an observation group (48 cases treated with neuroendoscopy-assisted surgery) were set according to different operation methods. The hematoma clearance rate, surgery-related indicators, related complications, hematoma recurrence rate and related prognostic indicators of the two groups were compared and analyzed. Results: The postoperative hematoma clearance rate of the observation group was 92.59%, which was higher than that of the control group (77.78%) (P<0.05). The operation time of the observation group was longer than that of the control group (P<0.05). The postoperative hospitalization time of the observation group was shorter than that of the control group (P<0.05). The postoperative complication rate of the observation group was lower than that of the control group (P<0.05). The recurrence rate of hematoma in the observation group in the six-month postoperative follow-up was 1.85%, which was lower than that in the control group (P<0.05). The limb motor function and daily living ability score of the observation group were higher than those of the control group, and the Markwalder grading score was lower than that of the control group (P<0.05). Conclusion: Neuroendoscopy-assisted treatment which is safe and effective is superior to traditional burr-hole drainage surgery. It can reduce the recurrence rate; thus, it is worth advocating and applying. doi: https://doi.org/10.12669/pjms.39.2.6642 How to cite this: Ma B, Song H, Lin W. Efficacy and prognosis of neuroendoscopy-assisted surgery for chronic subdural hematoma. Pak J Med Sci. 2023;39(2):578-582. doi: https://doi.org/10.12669/pjms.39.2.6642 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Efficacy analysis of flexible neuroendoscopy combined with dry-field techniques in the treatment of chronic subdural hematoma

Abstract: Supplemental Digital Content is available in the text

Cited by 10 publications

References 11 publications

A Clinical Study of the Intra-Neuroendoscopic Technique for the Treatment of Subacute-Chronic and Chronic Septal Subdural Hematoma

A Clinical Study of the Intra-Neuroendoscopic Technique for the Treatment of Subacute-Chronic and Chronic Septal Subdural Hematoma

Clinical study on the selection of endoscopes and microscopes for transsphenoidal surgery of non-aggressive pituitary macroadenoma and microadenoma and the influencing factors of hyposmia after endoscopic transsphenoidal surgery

Efficacy and prognosis of neuroendoscopy-assisted surgery for chronic subdural hematoma

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