Endoscopic hematoma evacuation for acute subdural hematoma with improvement of the visibility of the subdural space and postoperative management using an intracranial pressure sensor

Abstract

Background: The first choice to treat acute subdural hematoma (ASDH) is large craniotomy under general anesthesia. However, increasing age or the comorbid burden of patients may render invasive treatment strategy inappropriate. These medically frail patients with ASDH may benefit from a combination of small craniotomy and endoscopic hematoma removal, which is less invasive. We proposed covering with protective sheets to prevent brain injury due to contact with the endoscope and suction cannula and improve visualization of the subdural space. Moreover, we placed an intracranial pressure (ICP) sensor after endoscopic hematoma removal. In this article, we attempted to clarify the use of small craniotomy evacuation with endoscopy for ASDH. Methods: Between January 2015 and December 2019, nine patients with ASDH underwent hematoma evacuation with endoscopy at our hospital. ASDH was removed using a suction tube with the aid of a rigid endoscope through the small craniotomy (5–6 cm). Improvement of the clinical symptoms and procedure-related complications was evaluated. Results: No procedure-related hemorrhagic complications were observed. The outcomes of our endoscopic surgery were satisfactory without complications or rebleeding. The outcomes were not inferior to those of other reported endoscopic surgeries. Conclusion: The results suggest that small craniotomy evacuation with endoscopy and postoperative management using an ICP sensor is a safe, effective, and minimally invasive treatment approach for ASDH in appropriately selected cases.

Successful Management of Acute Subdural Hematoma in Deep Brain Stimulation Patient: A Case Report and Literature Review

“…The number of reports on the use of endoscopic hematoma evacuation for ASDH is increasing [ 12 - 14 ]. Tanaka et al reported that endoscopic hematoma evacuation of ASDH with a cerebrospinal fluid shunt is a safe and effective approach to preserve the shunt by making a skin incision parallel to the shunt catheter [ 14 ].…”

A Case of Two-stage Surgery Using Intracranial Pressure Monitoring for Hemorrhagic Infarction during Direct Oral Anticoagulant Medication

“…In severe traumatic brain injury, stepwise intracranial pressure (ICP) control under ICP monitoring has been recommended, following a previously reported staged surgical treatment strategy for severe head traumas (3) , (4) , (5) , (6) .…”

Endoscopic-assisted removal of bilateral traumatic intracerebral hemorrhage: A case report

“…Although insufficient for hemostasis, endoscopic surgery is less invasive and can sufficiently reduce intracranial pressure relative to craniotomy or craniectomy. [ 12 , 13 ] Recent studies suggest that endoscopic surgery can provide both adequate decompression and maximize neurological recovery in patients with TBI. [ 12 , 13 ] Furthermore, patients with TBI undergoing unilateral decompression surgery for hematoma evacuation are at risk of contralateral hematoma enlargement.…”

“…[ 12 , 13 ] Recent studies suggest that endoscopic surgery can provide both adequate decompression and maximize neurological recovery in patients with TBI. [ 12 , 13 ] Furthermore, patients with TBI undergoing unilateral decompression surgery for hematoma evacuation are at risk of contralateral hematoma enlargement. [ 3 , 5 , 10 ] This report describes the case of an elderly patient who developed bilateral TICH following a fall.…”