Endoscopic Hematoma Evacuation for Acute Subdural Hematoma in the Elderly: A Preliminary Study

Matsumoto, Hiroaki; Minami, Hiroaki; Hanayama, Hiroaki; Yoshida, Yasuhisa

doi:10.1177/1553350618785270

Cited by 9 publications

(16 citation statements)

References 12 publications

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“…The median operative time in our study of 107 minutes was similar to that reported in the previous series of endoscopic-assisted subdural hematoma evacuations found in the literature [19][20][21]23,24]. There will definitely be a learning curve for neurosurgeons unfamiliar with the use of the endoscope in their daily practice that will impact the operative time at first, but as with any other newly learned technique, continuous use will likely improve surgical procedure duration.…”

Section: Discussionsupporting

confidence: 82%

“…There will definitely be a learning curve for neurosurgeons unfamiliar with the use of the endoscope in their daily practice that will impact the operative time at first, but as with any other newly learned technique, continuous use will likely improve surgical procedure duration. The operative time for standard craniotomy/craniectomy for acute subdural hematoma evacuation reported in the literature has a wide range of reported times as short as 49 minutes to longer than two hours [21,[25][26][27].…”

Section: Discussionmentioning

confidence: 99%

“…The technical advantages of the endoscope enable the surgeon to reduce blood loss, reduce the operative time, minimize the size of the craniotomy, and potentially enhance postoperative recovery. Recent publications suggest that endoscopic-assisted evacuation of acute subdural hematomas through a small craniotomy could be safe and feasible in ideal candidates [17][18][19][20][21][22][23][24]. We retrospectively reviewed our experience in endoscope-assisted acute and acute-on-chronic subdural hematoma evacuation in what represents the largest series on this subject.…”

Section: Introductionmentioning

confidence: 99%

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Endoscope-Assisted Evacuation of Acute-on-Chronic Subdural Hematomas: A Single-Center Series

Urquiaga¹,

Patel²,

Tecle³

et al. 2022

Cureus

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Purpose: Acute subdural hematomas are frequent, highly morbid, and affect all age groups. The most common mechanism of injury is a low-velocity fall, and the incidence of the disease is growing due to increasingly aggressive antithrombotic and anticoagulant therapies. In this study, we aimed to share our experience with the endoscopic-assisted evacuation of acute subdural hematoma, a less invasive procedure compared to standard craniotomy.Methods: We retrospectively reviewed data of all consecutive patients aged 18 years and older who underwent endoscopic-assisted evacuation of acute-on-chronic subdural hematoma at our institution from 2015 to 2019. Preoperative, intraoperative, postoperative, and follow-up data were collected and reported. Statistical tests were done using Python statistical packages.Results: Of the 35 patients that underwent this procedure, 32 were 18 years and older. The median age was 69.5 years and 37.5% were female. Twenty patients (62.5%) were on antiplatelet therapy, and six patients (18.75%) were on anticoagulants upon presentation. A fall was the most common cause of trauma (71.88%). The median operative time was 107 minutes. The median length of stay in days and Glasgow Coma Scale (GCS) at discharge were 8.5 and 15, respectively. There were no surgical site infections or in-hospital mortality in this series. At the latest follow-up, the median GCS and modified Rankin Scale were 15 and 1, respectively.Conclusion: Evacuation of acute-on-chronic subdural hematomas can be performed safely and efficiently via a smaller craniotomy and with the assistance of an endoscope. This may represent a less invasive alternative than standard craniotomy/craniectomy in selected patients.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Endoscope-Assisted Evacuation of Acute-on-Chronic Subdural Hematomas: A Single-Center Series

Urquiaga¹,

Patel²,

Tecle³

et al. 2022

Cureus

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“…ere have been increasing reports of the use of endoscopic hematoma evacuation for ASDH in the elderly. [1][2][3][4][5][7][8][9][10][11][12][13][14] In a recent scoping review, mortality rates ranged between 0% and 40%, whereas the rate of favorable outcomes ranged between 26.7% and 96.4%. [13] Rebleeding was the most commonly reported complication, with a prevalence ranging between 0% and 13%.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, reports on endoscopic hematoma removal with small craniotomy for ASDH have been increasing. [1][2][3][4][5][7][8][9][10][11][12][13][14] is minimally invasive surgery could compensate for the disadvantages of craniotomy and craniectomy. In this study, we report a case series of nine patients with ASDH who underwent endoscopic hematoma removal with small craniotomy under general anesthesia.…”

Section: Introductionmentioning

confidence: 99%

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

Tanaka

Goto

Momozaki

et al. 2023

Surgical Neurology International

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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.

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Endoscope-assisted techniques for evacuation of acute subdural haematoma in the elderly: The lesser of two evils? A scoping review of the literature

Spencer

Manivannan

Zaben

2021

Clinical Neurology and Neurosurgery

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Endoscopic Hematoma Evacuation for Acute Subdural Hematoma in the Elderly: A Preliminary Study

Abstract: Our surgical procedure is safe and effective when performed with strict operative indications. Endoscopic surgery for ASDH in elderly adults may be an alternative to a large craniotomy in simple-type hematomas.

Cited by 9 publications

References 12 publications

Endoscope-Assisted Evacuation of Acute-on-Chronic Subdural Hematomas: A Single-Center Series

Endoscope-Assisted Evacuation of Acute-on-Chronic Subdural Hematomas: A Single-Center Series

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

Endoscope-assisted techniques for evacuation of acute subdural haematoma in the elderly: The lesser of two evils? A scoping review of the literature

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