Endoscopic hematoma evacuation for acute subdural hematoma in a young patient: a case report

Kuge, Atsushi; Tsuchiya, Daisuke; Watanabe, Shigeki; Sato, Mitsuya; Kinjo, Toshihiko

doi:10.1002/ams2.295

Cited by 16 publications

(21 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients with an enlarging SDH and associated brain contusions, who were excluded by Yokosuka et al, 9 may be eligible for the technique as long as bipolar cautery is available. Interestingly, a young man with schizophrenia underwent successful removal of an SDH using a rigid endoscope, 18 and his brain atrophy allowed some cerebral swelling without complications.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Treatment of Acute Subdural Hematoma with a Normal Small Craniotomy

Hwang

Shin

2019

J Neurol Surg A Cent Eur Neurosurg

View full text Add to dashboard Cite

Background Endoscopic surgery is helpful in evacuating intracranial hematomas. However, the indication and the craniotomy location are still unclear in the endoscopic evacuation of acute subdural hematomas (SDHs). This study evaluated the feasibility and efficacy of endoscopic treatment of acute SDH via a normal small craniotomy. Methods A normal small craniotomy (∼ 3 × 4 cm) as a surgical window was made at the superior temporal line around the coronal suture on the lesion side. A 4-mm rigid endoscope with a 0-degree lens was introduced into the subdural space, and the hematoma was evacuated using irrigation and suction devices with various angles. Endoscopic surgery was performed in 13 older adult patients with acute SDH. Adequacy of the hematoma evacuation, bleeding control, and clinical outcomes were analyzed. Results The mean age of the patient was 78.6 years (range: 65–89 years). Four cases of cortical arterial bleeding were encountered and controlled with bipolar cauterization. No re-bleeding was observed postoperatively in any patient. Near-total hematoma removal was achieved. Remnant hematoma was scanty and located in the parietal area. No further craniectomy was required after the endoscopic surgery. The outcome at discharge was closely related to the patient's level of consciousness before the operation. Conclusion A small craniotomy around the superior temporal line provides an optimal window to evacuate an acute SDH and achieve hemostasis using an endoscope. Endoscopic evacuation of acute SDHs could be effective in selected cases.

show abstract

Section: Discussionmentioning

confidence: 99%

Endoscopic Treatment of Acute Subdural Hematoma with a Normal Small Craniotomy

Hwang

Shin

2019

J Neurol Surg A Cent Eur Neurosurg

View full text Add to dashboard Cite

show abstract

“…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%

“…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%

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)

View full text Add to dashboard Cite

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.

show abstract

“… 14 36) And endoscopic removal of ASDH have been reported recently. 19 41 51 56 100) But, no well-designed comparative study or large case series is reported and clinical experiences are limited up to now. And also, indications for the endoscopic surgery have not been well established.…”

Section: Surgical Management Of Asdhmentioning

confidence: 99%

“…Endoscopic evacuation of traumatic ASDHs was achieved through a burr-hole. 56 100) But, it could not give enough window to accommodate the surgical instruments. And complete hemostasis may not be achieved with burr-hole procedure and rebleeding was reported after surgery.…”

Section: Surgical Management Of Asdhmentioning

confidence: 99%

Neurocritical Management of Traumatic Acute Subdural Hematomas

Shin

Hwang

2020

Korean J Neurotrauma

View full text Add to dashboard Cite

Acute subdural hematoma (ASDH) has been a major part of traumatic brain injury. Intracranial hypertension may be followed by ASDH and brain edema. Regardless of the complicated pathophysiology of ASDH, the extent of primary brain injury underlying the ASDH is the most important factor affecting outcome. Ongoing intracranial pressure (ICP) increasing lead to cerebral perfusion pressure (CPP) decrease and cerebral blood flow (CBF) decreasing occurred by CPP decrease. In additionally, disruption of cerebral autoregulation, vasospasm, decreasing of metabolic demand may lead to CBF decreasing. Various protocols for ICP lowering were introduced in neuro-trauma field. Usage of anti-epileptic drugs (AEDs) for ASDH patients have controversy. AEDs may reduce the risk of early seizure (<7 days), but, does not for late-onset epilepsy. Usage of anticoagulants/antiplatelets is increasing due to life-long medical disease conditions in aging populations. It makes a difficulty to decide the proper management. Tranexamic acid may use to reducing bleeding and reduce ASDH related death rate. Decompressive craniectomy for ASDH can reduce patient's death rate. However, it may be accompanied with surgical risks due to big operation and additional cranioplasty afterwards. If the craniotomy is a sufficient management for the ASDH, endoscopic surgery will be good alternative to a conventional larger craniotomy to evacuate the hematoma. The management plan for the ASDH should be individualized based on age, neurologic status, radiologic findings, and the patient's conditions.

show abstract

Endoscopic hematoma evacuation for acute subdural hematoma in a young patient: a case report

Cited by 16 publications

References 7 publications

Endoscopic Treatment of Acute Subdural Hematoma with a Normal Small Craniotomy

Endoscopic Treatment of Acute Subdural Hematoma with a Normal Small Craniotomy

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

Neurocritical Management of Traumatic Acute Subdural Hematomas

Contact Info

Product

Resources

About