Usefulness of neuroendoscopic surgery for chronic subdural hematoma with organized hematoma, septal formation, viscous hematoma

Abstract

The surgical treatment of chronic subdural hematoma (CSDH) is generally performed by irrigation and drainage via burr hole. Recently, endoscopic procedure has also been used for neurosurgery due to its minimally invasiveness and advantages. In this report, we describe the usefulness of neuroendoscopic procedure for CSDH. Of the 309 CSDH cases with 382 sides were operated on between April 2018 and March 2022. Nine sides of these patient underwent neuroendoscpic procedure. The mean age was 84.4 years, 6 cases were male. The left side were 6, and the right side were 3 cases. There were 4 recurrent cases. We discussed the reason for neuro­endoscopic use, intraoperative findings, and postoperative course. Neuroendoscope was introduced because of the preoperative evalua­tion of radiological examinations, which showed initial treatment in 2 cases, and that was considered difficult to irrigate intraoperatively in 1 case. Patients who were assessed as difficult to irrigate pre­operatively based on radiological images continued to show organiz­ing hematoma, septal formation, and other findings intraoperatively. Operation time ranged from 49–115 minutes (median 65 min). The hospital dayranged 9–55 days (median 15 days). No cases of recurrent CSDH were observed after neuroendoscopic procedure during follow up period (30–133 days). The outcome was that 7 patients were discharged home or to their original facility after improving to the state before the onset of the disease, and 2 patients were transferred to a rehabilitation center. Two patients had a decrease in the modified Rankin Scale from the onset, 1 patient had postoperative pneumonia and 1 patient had pleural effusion. Although the number of cases in which neuroendoscopic procedure was introduced in the surgical treatment of CSDH is not large, 9 of 382 (2.4%), all of the cases re­viewed in this study had features that could not be treated by conventional irrigation and drainage, suggesting that neuroendoscopic pro­cedure would be useful.