Evacuation Of Subdural Hematoma Research Articles

Monitored anesthesia care: Dexmedetomidine-ketamine versus dexmedetomidine-propofol combination during burr-hole surgery for chronic subdural hematoma: A randomized trial

Background and Aim: Selecting the ideal drug combination for effective monitored anesthesia care to keep patients comfortable and safe during evacuation of chronic subdural hematoma is a challenge. Our hypothesis was that the combination of dexmedetomidine with ketamine might provide safer monitored anesthesia care keeping airway patency and stable hemodynamics in comparison to dexmedetomidine-propofol combination during burr-hole surgery for evacuating chronic subdural hematoma in high-risk patients.Methods: A total of 56 paticipants were allocated into two groups in this randomized prospective double-blind study by a computer-generated randomization table. DK group (n = 28): Patients were given a mix of ketamine (1 mg/kg) and dexmedetomidine (1 µg/kg) diluted in 10 ml of saline solution infused over 10 min as an intravenous bolus dose. This was followed by a continuous infusion of 0.5 µg/kg/h dexmedetomidine with 0.5 mg/kg/h ketamine. DP group (n = 28): Patients were given a mix of propofol (0.5 mg/kg) and dexmedetomidine (1 µg/kg) diluted in 10 ml of saline solution infused over 10 min as an intravenous bolus dose. This was followed by a continuous infusion of 0.5 µg/kg/h dexmedetomidine with 0.5 mg/kg/h propofol. The infused solutions were in two separate syringe pumps. The target was to achieve a modified Observer's Assessment of Alertness and Sedation score (OAA/S) of 3, and the infusion was stopped by finishing the skin suture.Results: The onset of sedation using OAA/S was significantly longer in the DK group (413.21 ± 49.18 s.) compared to (297.21 ± 37.68 s.) in the DP group. The number of participants with an airway obstruction score of 1 and 2 was significantly higher in the DK group compared to the DP group; however, those with a score of 3 were significantly higher in the DP group. The total number of patients needing intraoperative fentanyl was comparable between groups. The number of patients who developed intraoperative hypotension, bradycardia, bradypnea, and hypoxemia was significantly higher in the DP group compared to the DK group (p < 0.05). There was an improvement in postoperative Markwalder's Neurological Grading Scale (MNG) scores compared to preoperatively in both the DK and DP groups. The recovery time was significantly longer in the DK group (8.75 ± 1.17 min) compared to (5.73 ± 0.75 min) in the DP group, with comparable surgeon satisfaction.Conclusions: Combining dexmedetomidine with ketamine is safer than dexmedetomidine with propofol for effective monitored anesthesia care in high-risk patients undergoing burr-hole surgery for evacuating chronic subdural hematoma.Institutional Review Board approval (ref: 6434/25-10-2020).ClinicalTrials.gov (ref: NCT04621526, the date of registration: 9-11-2020).

Mini-Craniotomy for Chronic Subdural Hematoma: A Reliable Surgical Option

Abstract Introduction Chronic subdural hematoma (SDH) is one of the most common conditions encountered in the neurosurgical practice. Surgical modalities like twist drill craniostomy, burr hole evacuation, mini-craniotomy, and craniotomy are practiced in the management of chronic SDH. Mini-craniotomy without excision of membranes may help to achieve best results with decreased complication rate. Materials and Methods Patients with chronic SDH operated from September 2013 to September 2022 were included in the study. Mini-craniotomy (40–60 mm) was done and cruciate incision was given over the dura. Dura was left wide open by reflecting and suturing the cut edges of the dural leaflets to the craniotomy edge allowing to evacuate subdural space under vision during surgery and to allow any residual collection to drain out freely in the postoperative period. A drain was placed between the inner membrane and the bone flap. Preoperative and postoperative clinical and radiological parameters were recorded. Complications, recurrence, and residual collections were noted. Results Seventy-seven patients were included in the study. Mean age was 57.32 years. Median Glasgow Coma Scale (GCS) at presentation was 13 while median GCS at discharge was 15. Two patients with preexisting comorbidities expired after surgery due to medical causes. No recurrences were noted. Fourteen patients had residual collections which resolved by 6 weeks. Two patients had wound infection. One of these patients later needed a bone flap removal due to osteomyelitis. Conclusion Mini-craniotomy without membranectomy is a good option for complete evacuation of chronic SDH under vision mainly avoiding the complication of membranectomy. It is not associated with increased complications rate. It needs fewer follow-ups as brain expansion can be established radiologically in a short period.

Comparison of the efficacy of 0.9% normal saline with balanced crystalloid (Plasmalyte) in maintaining the metabolic profile in head injury patients undergoing evacuation of acute subdural haematoma – A randomised controlled trial

Background and Aims: The choice of intravenous fluids is important in patients with traumatic brain injury (TBI), where large volumes may be required for resuscitation. Our study aimed to compare 0.9% normal saline (NS) with balanced crystalloid (Plasmalyte) in TBI patients in terms of metabolic and coagulation profile, brain relaxation score (BRS) and renal functions using serum urea, creatinine and urinary tissue inhibitor of metalloproteinases-2* insulin-like growth factor binding protein-7, [TIMP-2]*[IGFBP7], value to assess the risk of acute kidney injury. Methods: This randomised controlled trial on 90 TBI patients undergoing emergency craniotomy and subdural haematoma evacuation was conducted in a tertiary care institute. The patients were randomised to receive either NS (Group NS) or Plasmalyte (Group P) as the intraoperative maintenance fluid. The primary outcome measures included the potential of hydrogen (pH), base excess (BE) and chloride values from an arterial blood gas. The secondary outcomes were the coagulation profile, BRS and urinary [TIMP-2]*[IGFBP7]. The two groups’ metabolic profile differences were analysed using two-way repeated analysis of variance. BRS was analysed using the Mann–Whitney U test. A P value &lt; 0.05 was considered to be statistically significant. Results: The pH and chloride values were significantly higher, and the BE values were significantly lower in Group P compared to Group NS (P &lt; 0.001). Brain relaxation and coagulation profiles were comparable between the two groups. Serum creatinine (P = 0.002) and urinary [TIMP-2]*[IGFBP7] (P = 0.042) were significantly higher in the NS group. Conclusion: Plasmalyte maintains a more favourable metabolic profile than NS in TBI patients without affecting brain relaxation adversely.

Quantitative assessment of brain expansion after evacuation of chronic subdural hematoma as a predictor of recurrence

Quantitative assessment of brain expansion after evacuation of chronic subdural hematoma as a predictor of recurrence

Comparison of Efficacy of Decompressive Craniectomy By Multiple Dural Stabs Versus Open Dural Flap For The Evacuation of Acute Subdural Hematoma

Comparison of Efficacy of Decompressive Craniectomy By Multiple Dural Stabs Versus Open Dural Flap For The Evacuation of Acute Subdural Hematoma

Acute Subdural Hematoma Evacuation

Dr. Prinz performs a craniotomy to gain access to and evacuate a subdural hematoma, relieving pressure that caused a midline shift and a compressed left ve

247 Novel Automated Active Irrigation With Drainage Leads to Significantly Faster Hematoma Clearance and Lower Catheter-related Infections Compared to Passive Drainage Alone for cSDHA Propensity Score-matched Comparative Study with Volumetric Analysis

INTRODUCTION: Passive drainage post-surgical evacuation of symptomatic chronic subdural hematoma (cSDH) is currently standard of care. High rates of infection, drain occlusion, and recurrence are associated complications. METHODS: A prospectively maintained database was retrospectively searched for consecutive patients presenting with cSDH. One-to-one PSM of covariates (including baseline comorbidities and presentation hematoma volume) in active and passive irrigation groups was performed to adjust for treatment selection bias. Rates of hematoma clearance, catheter-related occlusion, and infection; number of revisions; and length of hospital stay were recorded. RESULTS: This study included 55 patients: active continuous irrigation-drainage-21 (21 post-PSM); passive drainage-34 (21 post-PSM). For PSM groups, a significantly higher rate of hematoma clearance was obtained in the active irrigation-drainage group (0.5±0.4 vs. 0.4±0.5 ml/day in the passive drainage group; odds ratio [OR] = 1.291 (confidence interval [CI]:1.062-1.570, P = 0.002) and a significantly lower rate of catheter-related infections (OR = 0.051; CI: 0.004-0.697, P = 0.039). A non-significantly lower hematoma expansion rate at discharge was noted in the active irrigation-drainage group (4.8% vs. 23.8%; OR = 0.127; P = 0.186). No statistical difference in all-cause in-hospital mortality or discharge GCS score was observed between groups. CONCLUSIONS: Active and automated continuous irrigation plus drainage following cSDH surgical evacuation results in faster hematoma clearance and led to favorable clinical outcomes and low complication and revision rates compared to passive irrigation.

124 Craniotomy Versus Craniectomy for Traumatic Acute Subdural Hematoma Coarsened Exact Matched Analysis of Outcomes

INTRODUCTION: Previous studies comparing craniotomy (CO) versus decompressive hemicraniectomy (DC) for acute subdural hematoma (aSDH) evacuation after traumatic brain injury have not found significant association between surgical approach and patient outcome. We hoped to provide a more granular and real-world assessment of outcomes. METHODS: One hundred thirty-eight patients underwent CO (N = 76) or DC (N = 62) for traumatic aSDH. DC patients were on average 21.4 years younger (P &lt; 0.001), more likely to be male (80.6% vs 60.5%, P = 0.011), and present with GCS = 8 (64.5% vs 36.8%, P = 0.001). Age (P &lt; 0.001), EDH (P = 0.01), skull fracture (P = 0.001), and cisternal effacement (P = 0.02) were independently associated with surgical approach. After coarsened exact matching, DC (P = 0.008), older age (P = 0.007), male sex (P = 0.04), and IVH (P = 0.02), were independently associated with inpatient mortality. Multivariate Cox proportional-hazards regression demonstrated that DC was independently associated with mortality at 90-days (P = 0.001) and 1-year post-operation (P = 0.003) for matched patients. RESULTS: One hundred thirty-eight patients underwent CO (N = 76) or DC (N = 62) for traumatic aSDH. DC patients were on average 21.4 years younger (P &lt; 0.001), more likely to be male (80.6% vs 60.5%, P = 0.011), and present with GCS = 8 (64.5% vs 36.8%, P = 0.001). Age (P &lt; 0.001), EDH (P = 0.01), skull fracture (P = 0.001), and cisternal effacement (P = 0.02) were independently associated with surgical approach. After coarsened exact matching, DC (P = 0.008), older age (P = 0.007), male sex (P = 0.04), and IVH (P = 0.02), were independently associated with inpatient mortality. Multivariate Cox proportional-hazards regression demonstrated that DC was independently associated with mortality at 90-days (P = 0.001) and 1-year post-operation (P = 0.003) for matched patients. CONCLUSIONS: aSDH patients who receive surgical evacuation via DC as opposed to CO are younger, more likely to be male, and have worse clinical exam. After controlling for patient differences via coarsened exact matching, DC is an independent predictor of mortality at discharge, as well as at 90-days and 1-year after surgery.

Dialysis disequilibrium syndrome in neurosurgery: literature review and illustrative case example.

The dialysis disequilibrium syndrome (DDS) is a complication in those undergoing dialysis for chronic kidney disease (CKD) or acute kidney injury (AKI), characterized by nonspecific symptoms that may progress to coma and death secondary to cerebral edema. This syndrome is associated with rapid change in electrolytes during dialysis with changes in intracranial pressure (ICP) and may have a higher incidence in the elderly neurosurgical patient population. Literature review and illustrative case example. A 62-year-old female presented with acute mental status change during hemodialysis (HD), with a history of a nonsurgical acute subdural hematoma (SDH) 10days prior. Imaging showed a conversion of the acute SDH to chronic SDH of 12.2mm in size with a 14.1 midline shift, for which she underwent a hemicraniectomy with SDH evacuation, with a gradual return to baseline. The literature review identified 5 publications meeting the inclusion criteria. Major theories of DDS include a reverse urea effect, intracerebral acidosis, idiogenic osmoles, and local inflammation. This complication may occur more frequently in the elderly neurosurgical patient population, likely due to age-related comorbidities, preexisting neurological insult, and increased permeability of the blood-brain barrier (BBB), leading to cerebral edema. DDS is a rare and potentially fatal complication of HD that may have a higher incidence in the elderly neurosurgical patient population, yet remains to be fully understood. Further study is recommended to characterize the pathophysiological mechanism and incidence of DDS in neurosurgical patients.

Surgical strategies in acute subdural hematoma: a meta-analysis of decompressive craniectomy vs. craniotomy.

Acute subdural hematoma (ASDH) stands as a significant contributor to morbidity after severe traumatic brain injuries (TBI). The primary treatment approach for patients experiencing progressive neurological deficits or notable mass effects is the surgical removal of the hematoma, which can be achieved through craniotomy (CO) or decompressive craniectomy (DC). Nevertheless, the choice between these two procedures remains a subject of ongoing debate and controversy. We conducted a comprehensive literature review, utilizing prominent online databases and manually searching references related to craniotomy and craniectomy for subdural hematoma evacuation up to November 2023. Our analysis focused on outcome variables such as the presence of residual subdural hematoma, the need for revision procedures, and overall clinical outcomes. We included a total of 11 comparative studies in our analysis, encompassing 4269 patients, with 2979 undergoing craniotomy and 1290 undergoing craniectomy, meeting the inclusion criteria. Patients who underwent craniectomy displayed significantly lower scores on the Glasgow Coma Scale (GCS) during their initial presentation. Following surgery, the DC group exhibited a significantly reduced rate of residual subdural (P = 0.009). Additionally, the likelihood of a poor outcome during follow-up was lower in the CO group. Likewise, the mortality rate was lower in the CO group compared to the craniectomy group (OR 0.63, 95% CI 0.41-0.98, I2 = 84%, P = 0.04). Our study found that CO was associated with more favorable outcomes in terms of mortality, reoperation rate, and functional outcome while DC was associated with less likelihood of residual subdural hematoma. Upon further investigation of patient characteristics who underwent into either of these interventions, it was very clear that patients in DC cohort have more serious and low pre-op characteristics than the CO group. Nonetheless, brain herniation and advanced age act as independent factor for predicting the outcome irrespective of the intervention.

Untoward outcomes of successful chronic subdural hematoma evacuation, cortical blindness and brain stem stroke: A Case series

Chronic subdural hematoma (CSDH) is one of the most commonly encountered emergencies in neurosurgery practice. Burr hole with drainage of hematoma has been a time-tested standard treatment with good results and in itself a simple procedure to relieve patient clinical status. However, apparently simple surgery may at times have an unexpected surgical outcome of bilateral vision loss. All bilateral CSDHs should be treated diligently with early recognition of any visual deterioration in post-operative phase if any and due to possible interventions to be offered to the patients for prevention of permanent vision loss.

Extreme-aged patients (≥ 85years) experience similar outcomes as younger geriatric patients following chronic subdural hematoma evacuation: a matched cohort study.

Subdural hematoma (SDH) evacuation represents one of the most frequently performed neurosurgical procedures. Several reports cite a rise in both the age and number of patient's requiring treatment, due in part to an aging population and expanded anticoagulation use. However, limited data and conflicting conclusions exist on extreme-aged geriatric patients (≥ 85years of age) after undergoing surgery. Patients undergoing SDH evacuation at a tertiary academic medical center between November 2013-December 2021 were retrospectively identified. The study group consisted of patients ≥ 85years (Group 1) diagnosed with a chronic SDH surgically evacuated. A control group was created matching patients by 70-84years of age, gender, and anticoagulation use (Group 2). Multiple metrics were evaluated between the two including length-of hospital-stay, tracheostomy/PEG placement, reoperation rate, complications, discharge location, neurological outcome at the time of discharge, and survival. A total of 130 patients were included; 65 in Group 1 and 65 in Group 2. Patient demographics, medical comorbidities, SDH characteristics, international normalized ratio, partial thromboplastin time, and use of blood thinning agents were similar between the two groups. Kaplan Meier survival analysis at one-year was 80% for Group 1 and 76% for Group 2. No significant difference was identified using the log-rank test for equality of survivor functions (p = 0.26). All measured outcomes including GCS at time of discharge, length of stay, rate of reoperations, and neurological outcome were statistically similar between the two groups. Backwards stepwise conditional logistic regression revealed no significant association between poor outcomes at the time of discharge and age. Alternatively, anticoagulation use was found to be associated with poor outcomes (OR 3.55, 95% CI 1.08-11.60; p = 0.036). Several outcome metrics and statistical analyses were used to comparepatients ≥ 85years of age to younger geriatric patients (70-84years) in a matched cohort study. Adjusting for age group, gender, and anticoagulation use, no significant difference was found between the two groups including neurological outcome at discharge, reoperation rate, and survival.

Template-based target point localization for occlusion of the middle meningeal artery during evacuation of space-occupying chronic subdural hematoma.

Endovascular middle meningeal artery (MMA) occlusion may help reduce the risk of recurrence after burr hole evacuation of chronic subdural hematoma (cSDH) but carries an additional periprocedural risk and remains hampered by logistical and financial requirements. In this study, the authors aimed to describe a simple and fast technique for preoperative MMA localization to permit burr hole cSDH evacuation and MMA occlusion through the same burr hole. The authors performed a preclinical anatomical and prospective clinical study, followed by a retrospective feasibility analysis. An anatomical cadaver study with 33 adult human skulls (66 hemispheres) was used to localize a suitable frontal target point above the pterion, where the MMA can be accessed via burr hole trephination. Based on anatomical landmark measurements, the authors designed a template for projected localization of this target point onto the skin. Next, the validity of the template was tested using image guidance in 10 consecutive patients undergoing elective pterional craniotomy, and the feasibility of the target point localization for cSDH accessibility was determined based on hematoma localization in 237 patients who were treated for a space-occupying cSDH in the authors' department between 2014 and 2018. In the anatomical study, the mean perpendicular distance from the zygomatic process to the target point in the frontoparietal bone was 4.1 cm (95% CI 4-4.2 cm). The mean length along the upper margin of the zygomatic process from the middle of the external auditory canal to the point of the perpendicular distance was 2.3 cm (95% CI 2.2-2.4 cm). The template designed according to these measurements yielded high agreement between the template-based target point and the proximal MMA groove inside the frontoparietal bone (right 90.9%; left 93.6%). In the clinical validation, we noted a mean distance of 4 mm (95% CI 2.1-5.9 mm) from the template-based target point to the actual MMA localization. The feasibility analysis yielded that 95% of all cSDHs in this cohort would have been accessible by the new frontal burr hole localization. A template-based target point approach for MMA localization may serve as a simple, fast, reliable, and cost-effective technique for surgical evacuation of space-occupying cSDHs with MMA obliteration through the same burr hole in a single setting.

Nonacute subdural hematoma evacuation via rigid endoscopy system: a clinical study

Nonacute subdural hematoma evacuation via rigid endoscopy system: a clinical study

Single-Center Comparison of Chronic Subdural Hematoma Evacuation Outcomes Under Local Versus General Anesthesia

Chronic subdural hematoma (CSDH) is a neurosurgical pathology of an aged populace. Pathogenetic risk factors include traumatic brain injury, prolonged use of antiplatelet drugs, hypertension, and some inflammatory processes. The incidence increases as patients age. Burr-hole evacuation is the most common approach in management of symptomatic cases. We compared evacuation of chronic subdural hematomas with general or local anesthesia (GA and LA, respectively) and evaluated the safety, economic benefits, effects of comorbidity, benefits, and shortcomings of both techniques. We conducted a retrospective study of 67 consecutive patients who had 74 procedures for CSDH in a single neurosurgical center, the Regional Clinic, Centre of Neurosurgery and Neurology, over a 3-year period. They were grouped into the GA group (n= 44) and LA group (n= 23). Mean duration of procedure, length of hospital stay, complications, and preoperative and postoperative neurologic statuses were compared. The distribution of nominal variables between groups was compared using the Fisher exact test. The average duration of operation and length of hospital stay were compared using the Mann-Whitney U-test due to violation of the normality assumption. LA proved to be as effective as GA in CSDH evacuation. Seventy-four surgical procedures were performed on 67 patients due to recurrence in less than 30 days in 7 patients. Fifteen patients had tension pneumocephalus managed with fluid therapy to full recovery. LA was economical and required shorter hospital stays and surgical time. In our studies, LA proved to be noninferior to GA, time conserving, and less prone to some of the adverse effects of GA on elderly patients with comorbidity, although some patients who are hyperactive or contraindicated to LA will require GA.

Patient perception and satisfaction in awake burr hole trepanation under local anesthesia for evacuation of chronic subdural hematoma

Evacuation of chronic subdural hematoma (CSDH) will be one of the most common neurosurgical procedures in the future in the increasingly aging societies. Performing cranial surgery on awake patients may place a psychological burden on them. Aim of this study was to evaluate the psychological distress of patients during awake CSDH relief. Patients with awake evacuation of CSDH via burr hole trepanation were included in our monocentric prospective study. Patient perception and satisfaction were measured using standardized surveys 3–5 days and 6 months after surgery. Among other questionnaires, the Hospital Anxiety and Depression and the Impact of Event Scale, were used to quantify patients' stress. A total of 50 patients (mean age 72.9 years (range 51 – 92)) were included. During surgery, 28 patients reported pain (mean 4.1 (SD 3.3)). Postoperatively, 26 patients experienced pain (mean 2.7 (SD 2.6)). Patients’ satisfaction with intraoperative communication was reported with a mean of 8.3 (SD 2.1). There was a significant negative correlation between intraoperatively perceived pain and satisfaction with intraoperative communication (p = 0.023). Good intraoperative communication during evacuation of CSDH in awake patients is associated with positive patient perception and correlates with pain reduction.

Efficacy of single burr hole with irrigation and sub-dural drain in the evacuation of chronic subdural hematoma

BackgroundChronic subdural hematoma (CSDH) remains one of the most common types of traumatic and spontaneous intracranial hematomas. The optimal method of treatment has not been definitely established. Surgical treatment options includes craniotomy, trephination, burrhole drainage and twist drill perforation. This study aimed at the evaluation of the clinical and radiological outcome after the efficacy of single burr hole with irrigation and sub-dural drain in the aim of successful evacuation of CSDH.ResultsA total of 53 patients were included in this study, the mean age of patients was 61.53 + 13.81 years. Results of the paired t test showed that the Glasgow coma scale has significantly improved by 0.89 points (p < 0.001) and that the average motor power has significantly improved for all individuals by 0.4 points (p = 0.043). We found that older aged patients have significantly less improvements in the postoperative motor power (r = − 0.317, p = 0.02) and require longer hospital stay (r = 0.32, p = 0.0197).ConclusionsA single burr hole with irrigation and leaving a subdural drain is safe procedure in managing subdural hematoma. We did not experience major adverse events related to drain insertion and efficient evacuation of collection and no obvious increase in mortality or morbidity rates.

Three-Vessel Anastomosis for Direct Multiterritory Cerebral Revascularization: Case Series.

Cerebral revascularization of multiple territories traditionally requires multiple constructs, serial anastomoses, or a combination of direct and indirect approaches. A novel 3-vessel anastomosis technique allows for direct, simultaneous multiterritory cerebral revascularization using a single interposition graft. We herein present our experience with this approach. Retrospective review of perioperative data and outcomes for patients undergoing multiterritory cerebral revascularization using a 3-vessel anastomosis from 2019 to 2023. Five patients met inclusion criteria (median age 53 years [range 12-73]). Three patients with complex middle cerebral artery aneurysms (1 ruptured) were treated with proximal ligation or partial/complete clip trapping and multiterritory external carotid artery-M2-M2 revascularization using a saphenous vein interposition graft. Two patients with moyamoya disease, prior strokes, and predominately bilateral anterior cerebral artery hypoperfusion were treated with proximal superficial temporal artery-A3-A3 revascularization using a radial artery or radial artery fascial flow-through free flap graft. No patients experienced significant surgery-related ischemia. Bypass patency was 100%. One patient had new strokes from vasospasm after subarachnoid hemorrhage. One patient required a revision surgery for subdural hematoma evacuation and radial artery fascial flow-through free flap debridement, without affecting bypass patency or neurologic outcome. On hospital discharge, median Glasgow Outcome Scale and modified Rankin Scale scores were 4 (range 3-5) and 2 (range 0-5), respectively. On follow-up, 1 patient died from medical complications of their presenting stroke; Glasgow Outcome Scale and modified Rankin Scale scores were otherwise stable or improved. The 3-vessel anastomosis technique can be considered for simultaneous revascularization of multiple intracranial territories.

Letter to the Editor Regarding “Contralateral Subdural Hematoma Following Surgical Evacuation of Acute Subdural Hematoma: Super-Early Intervention and Clinical Implications”

Letter to the Editor Regarding “Contralateral Subdural Hematoma Following Surgical Evacuation of Acute Subdural Hematoma: Super-Early Intervention and Clinical Implications”

Endoscopic evacuation of chronic subdural hematoma with rigid and flexible endoscope: case report

Introduction: Subdural haematoma (SDH) is a common neurosurgical condition after head trauma requiring evacuation to prevent secondary brain injury. The first choice of management in these patients is a large craniotomy or burr-hole evacuation. However, sometimes due to lack vision during drain tube insertion or irrigation the authors might land up in a complication like cortical bridging vein rupture, haemorrhage etc. Also, the management of septate chronic SDH (CSDH) with multiple neo-membranes does not have a well-defined surgical approach. Recently, endoscopic evacuation has been reported to a be a feasible method for evacuation in acute, subacute and chronic SDH patients. Presentation of case: A 65-years-old male patient presented with a history of recent head injury and symptoms of headache and urinary incontinence of 7 days (Glasgow Coma Scale Score 15/15). Computed tomography scan revealed CSDH at both fronto-parietal convexity more on right side. Discussion: The authors reported our initial experience on a typical case of an older patient with chronic subdural haematoma and its evacuation with the assistance of both rigid and flexible endoscope. The authors could visualize cortical bridging veins and neo-membranes intraoperatively and guided our drainage tube accordingly to avoid inadvertent haemorrhage. There was no recurrence of symptoms postoperatively. Thus we achieved apparent successful evacuation of the CSDH in this patient in a 6-month follow-up. Conclusion: Endoscopic evacuation of CSDH proves to be an effective minimally invasive modality and more studies are required on larger patient groups with long-term follow-up imaging to confirm its superiority.