2021 Volume 26 Issue 2 Pages 159-166
Acute subdural hematoma (ASDH) is a severe and sometimes fatal disease. The standard treatment for ASDH is a large craniotomy under general anesthesia, which is invasive and risky for elderly patients with comorbidities. It is also occasionally difficult to determine the indications for an ASDH in elderly patients. The application of neuroendoscopic surgery for ASDH was recently described. Here we report the cases of six elderly patients who underwent an endoscopic surgery via a small‒size craniotomy for ASDH. We analyzed the effectiveness and the problems of this procedure and the related literature.
At our hospital between 2017 and 2020, six patients (age 70‒87 years old, mean 78 yrs; four males and two females) underwent an endoscopic surgery for ASDH. Three patients had been receiving antithrombotic drugs. The mean preoperative modified Rankin Scale (mRS) and Glasgow Coma Scale (GCS) scores were 2.2 (0‒4) and 7.8 (4‒12), respectively. The choice between general and local anesthesia depended on the patient’s condition. Gross total removal of the hematoma was achieved in five patients; partial removal was achieved in the other patient. The mean operation time of the six endoscopic surgeries was 94 min (67‒110 min), which was significantly shorter than that of 12 elderly patients who underwent a conventional craniotomy (150 min, range 82‒250 min) during the same period as this study (p ＜ 0.05). There was no postoperative bleeding or infection in the present series, and the six patients’ mean GCS score at 3 months post‒surgery was 3.3.
With careful attention to hemostasis and brain swelling, this endoscopic surgery could be a safe and effective option for treating ASDHs in elderly patients. This surgical approach is feasible under local anesthesia in some cases. Although further experiences are needed before conclusions can be drawn, the present six cases indicate that endoscopic surgery can be a useful option for treating an ASDH.
