Endoscopic Surgery for Traumatic Acute Subdural Hematoma

Abstract

Traumatic acute subdural hematoma (ASDH) is generally addressed by craniotomy under general anesthesia. We report a patient whose traumatic ASDH was treated under local anesthesia by one-burr-hole endoscopic surgery. This 87-year-old woman had undergone coil embolization for a ruptured right middle-cerebral artery aneurysm and placement of a ventriculoperitoneal shunt for normal pressure hydrocephalus 5 years earlier. Upon admission, she manifested consciousness disturbance after suffering head trauma and right hemiplegia. Her Glasgow Coma Scale score was 8 (E2V2M4). Computed tomography (CT) demonstrated a thick, left-frontotemporal ASDH. Due to her advanced age and poor condition, we performed endoscopic surgery rather than craniotomy to evacuate the ASDH. Under local anesthesia, we made a burr hole in her left forehead and increased its size to 15 mm in diameter. After introducing a transparent sheath into the hematoma cavity with a rigid endoscope, the clot was evacuated with a suction tube. The arterial bleeding point was electrically coagulated. A postoperative CT scan confirmed the reduction of the hematoma. There was neither brain compression nor brain swelling. Her consciousness disturbance and right hemiplegia improved immediately.Endoscopic surgery may represent a viable method to address traumatic intracranial hematomas in some patients.

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

“…Adverse effects such as a blood loss and brain swelling could occur 5, 6. Although the usefulness of endoscopic surgery as a minimally invasive procedure for subdural hematoma has been reported in elderly patients,1, 2, 3, 4 there has been no report of endoscopic surgery applied for ASDH in young patients.…”

“…Recently, an endoscopic procedure has been applied for elderly patients because of its minimal invasiveness 1, 2, 3, 4. Although there have been no previous reports of this endoscopic procedure being applied to young patients, we report a case and discuss its difficulties and tips to solve these problems.…”

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

“…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.…”

“…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.…”

Endoscopic-assisted removal of traumatic brain hemorrhage: case report and technical note

“…Considering these advantages, two groups applied the endoscopic technique for acute subdural hematomas drainage [ 7 , 8 ] describing one case of non-traumatic and other traumatic large acute subdural hematomas. The patients were 86 and 87 years old, both with good neurological recovery.…”