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

Abstract

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.

Endoscopically Treated Subacute Subdural Hematoma Presenting Postoperative Cerebral Hyperperfusion Syndrome: Chronological Changes of Cerebral Blood Flow on Arterial Spin Labeling and Subcortical Low Intensity on Fluid-attenuated Inversion Recovery Images

“…However, we could remove the hematoma only about half by the endoscopic procedure due to hard hematoma while the reported removal rates for ASDH and CSDH were higher than that in this case. 11 , 26) Also, general anesthesia has neuroprotective effects by reducing cerebral edema and intracranial pressure 36 , 37) but we did not use it. Therefore, general anesthesia could have prevented the CHP syndrome by providing neuroprotective effects.…”

“…Recently, in addition to ASDH 26) and CSDH, 11) reports about endoscopic hematoma removal with small craniotomy for SASDH have been increasing. [27][28][29][30][31][32][33][34][35] This minimally invasive surgery could address the disadvantages of craniotomy, such as massive blood loss and the side effects of the general anesthesia, especially for the elderly with multiple comorbidities.…”

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

“…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.…”

Advances in Traumatic Brain Injury Biomarkers

“…Although less than 10% of TBI cases are severe, they account for more than 80% of the total related global cost which is estimated to be 400 billion dollars/year [ 10 , 11 ]. The management of severe TBI (featuring compromised cranial vault/space-occupying lesions, medically refractory intracranial hypertension) starts with surgical debridement, and despite its effectiveness in increasing survival, there is no clear correlation with improving outcomes [ 12 , 13 ]. TBI survivors are typically managed in the intensive care unit (ICU) setting, involving invasive monitoring to measure intracranial pressure (ICP), partial pressure of oxygen in brain tissue (PbtO 2 ), and, less commonly, intracerebral flow, intracortical electroencephalogram (EEG), and microdialysis [ 14 ].…”