Efficacy of Neuroendoscopic Treatment for Septated Chronic Subdural Hematoma

Abstract

Objective: Neuroendoscopic treatment is an alternative therapeutic strategy for the treatment of septate chronic subdural hematoma (sCSDH). However, the safety and efficacy of this strategy remain controversial. We compared the clinical outcomes of neuroendoscopic treatment with those of standard (large bone flap) craniotomy for sCSDH reported in our center. Furthermore, the safety and efficacy of the neuroendoscopic treatment procedure for sCSDH were evaluated.Methods: We retrospectively collected the clinical data of 43 patients (37 men and six women) with sCSDH who underwent either neuroendoscopic treatment or standard (large bone flap) craniotomy, such as sex, age, smoking, drinking, medical history, use of antiplatelet drugs, postoperative complications, sCSDH recurrence, length of hospital stay, and postoperative hospital stay. We recorded the surgical procedures and the neurological function recovery prior to surgery and 6 months following the surgical treatment.Results: The enrolled patients were categorized into neuroendoscopic treatment (n = 23) and standard (large bone flap) craniotomy (n = 20) groups. There were no differences in sex, age, smoking, drinking, medical history, antiplatelet drug use, postoperative complications, and sCSDH recurrence between the two groups (p > 0.05). However, the patients in neuroendoscopic treatment group had a shorter length of total hospital stay and postoperative hospital stay as compared with the standard craniotomy group (total hospital stay: 5.26 ± 1.89 vs. 8.15 ± 1.04 days, p < 0.001; postoperative hospital stay: 4.47 ± 1.95 vs. 7.96 ± 0.97 days, p < 0.001). The imaging and Modified Rankin Scale at the 6-month follow-up were satisfactory, and no sCSDH recurrence was reported in the two groups.Conclusions: The findings of this study indicate that neuroendoscopic treatment is safe and effective for sCSDH; it is minimally invasive and could be clinically utilized.

Endoscopic Treatment of Chronic Subdural Hematoma Combined with Inner Subdural Hygroma

“…Many reports have discussed endoscopic treatment of CSDH. Septated CSDH, organized CSDH, recurrent CSDH, subacute subdural hematoma, and acute subdural hematoma have been reported to have been treated by endoscopy [ 3 , 5 , 14 , 29 , 32 ]. Trabecular type (septated type) had many fibrous septa and an old hematoma in the CSDH space [ 8 ].…”

“…Trabecular type (septated type) had many fibrous septa and an old hematoma in the CSDH space [ 8 ]. The fibrous septa and hematoma could be removed and aspirated safely by endoscopic assistance surgery [ 5 , 6 , 32 ]. Ichimura et al12) described inner membranotomy for the treatment of recurrent CSDH.…”

“…Although the pathophysiology of CSDH is not clearly understood, angiogenesis, fibrinolysis, and inflammation are involved in the evolution of CSDH, which is presented by the formation of a membrane and hemorrhage 7,11,23,31) . Computerized tomography (CT) is the initial diagnostic tool and provides extensive information on the ra-J Korean Neurosurg Soc 66 (5) : 552-561 diological characteristics of CSDH. More information such as the age of the hematoma, location, contents, and internal structures might be identified by magnetic resonance imaging (MRI) 9,15,17) .…”

“…Although burr-hole trephination with closed system drainage is widely accepted and performed, an optimal treatment method for CSDH has not yet been established. In recent years, endoscopic treatment of CSDH has been performed in complicated and recurrent cases, and there have been many reports about the safety and efficacy of treatment of CSDH via endoscopy [ 5 , 10 , 12 , 27 ].…”

Analysis of the Efficacy of Neuroendoscopic Hematoma Evacuation in the Treatment of Chronic Subdural Hematoma and its Influence on the Neurological Function of Patients

“…In addition, neuroendoscopic treatment of patients with septal CSDH can cause damage to the fibrous septum and lay a favorable foundation for hematoma aspiration. In neuroendoscopic hematoma evacuation, the problems of blind puncture and blind hemostasis can be avoided through electrocoagulation, thus improving the success rate of hemostasis [6] . According to relevant literature, , neuroendoscopic hematoma evacuation has a higher success rate of hematoma evacuation in CSDH patients and also a lower risk of recurrence compared to conventional soft channel drainage [7] .…”