Endoscopic hematoma evacuation following emergent burr hole surgery for acute subdural hematoma in critical conditions: Technical note

Maruya, Jun; Tamura, Satoshi; Hasegawa, Ryo; Saito, A; Nishimaki, Keiichi; Fujii, Yukihiko

doi:10.1016/j.inat.2018.01.005

Cited by 8 publications

(12 citation statements)

References 7 publications

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“…Most ASDHs were due to falls. The median GCS score on admission was 8 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15). The median hematoma volume was 140 (87-252) mL, and the midline shift was 12 (5-25) mm.…”

Section: Discussionmentioning

confidence: 99%

“…Two patients had rebleeding. The median GCS score 7 days after the operation was 14 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Three (20%) patients had favorable outcomes, and five died.…”

Section: Discussionmentioning

confidence: 99%

“…Table 4 summarizes previous reports of patients with true ASDH (but not subacute SDH) treated by means of endoscopic procedures. [4][5][6][7][8][10][11][12][13] Our case Weights are based on results from a treatment selection model, estimated using logistic regression with endoscopy or craniotomy as the dependent variable and the baseline characteristics of age, sex, history of cardiovascular disease, use of antithrombotic drugs, GCS score on admission, hematoma volume, midline shift, preoperative APTT, PT-INR, and platelet count as independent variables. The weights for each patient were calculated as the inverse of the probability of receiving the treatment.…”

Section: Elderly Patients With Asdhmentioning

confidence: 99%

“…On average, 22.7% of patients with traumatic brain injury experience coagulopathy upon emergency room arrival, and this acute traumatic coagulopathy (ATC) may influence hemostasis or the occurrence of intracranial hematoma, which can lead to unfavorable outcomes. 1,10,23) ATC reaches a peak level in 3 to 6 hours, 24) and invasive large craniotomy or craniectomy would increase risk for difficulty in hemostasis under the ATC condition. Hagihara and Takayama et al suggested monitoring hemostatic markers including d-dimer for coagulopathy status.…”

Section: Endoscopic Procedures and Intraoperative Bleeding Amountmentioning

confidence: 99%

“…Recently, reports on endoscopic hematoma removal with small craniotomy for ASDH have been increasing. [4][5][6][7][8][9][10][11][12][13] This minimally invasive surgery could possibly compensate for the disadvantages of craniotomy and craniectomy under general anesthesia. However, its efficacy remains unclear because the reports on endoscopic hematoma removal remain scarce.…”

Section: Introductionmentioning

confidence: 99%

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Fifteen Cases of Endoscopic Treatment of Acute Subdural Hematoma with Small Craniotomy under Local Anesthesia: Endoscopic Hematoma Removal Reduces the Intraoperative Bleeding Amount and the Operative Time Compared with Craniotomy in Patients Aged 70 or Older

Katsuki

Kakizawa

Nishikawa

et al. 2020

Neurol. Med. Chir.(Tokyo)

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We report cases of acute subdural hematoma (ASDH) treated by endoscopic hematoma removal with a small craniotomy under local anesthesia. From 2015 to 2019, we retrospectively analyzed 15 ASDH patients who were 70 years or older and met our criteria for endoscopic treatment: (1) comorbidities indicated risks associated with a large craniotomy under general anesthesia; (2) decompressive craniectomy was unlikely; and (3) an enlarging hematoma was absent. We also performed a case-control study using the inverse probability weighting method to compare the 15 patients to 20 ASDH patients who were 70 years or older, met criteria (2) and (3), and were treated by craniotomy between 2012 and 2019. Among the 15 ASDH patients, the median age was 86 (range, 70-101) years, and fall was the common cause. The median Glasgow Coma Scale score on admission, operative time, stay time in the operation room, and bleeding amount were 8 (6-15), 91 (48-156) min, 120 (80-205) min, and 20 (5-400) mL, respectively. The extraction rates of all the hematomas exceeded 90%. No patients required conversion to craniotomy under general anesthesia. Three patients had favorable outcomes, and five died. The comparison with craniotomy revealed that the endoscopic procedure reduced the intraoperative bleeding amount, operative time, and stay time in the operation room (p <0.001, p = 0.02, and p <0.001, respectively). In summary, endoscopic hematoma removal for selected ASDH patients aged 70 years or older did not improve functional outcomes but reduced the bleeding amount and the operative time compared with craniotomy.

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