Technical NoteEndoscopic-assisted evacuation of subdural collections
Introduction
There are three principal techniques to address chronic subdural haematoma (SDH): (i) twist drill craniostomy, (ii) burr-hole craniostomy, and (iii) craniotomy. They have different profiles for morbidity, mortality, recurrence rate and cure rate.1 Twist drill and burr-hole craniostomy can be considered first tier treatments, whereas craniotomy may be used as a second tier treatment.
The overall post-operative outcome of surgical treatment for chronic SDH has not improved substantially over the past 20 years.2 We conducted the present study to establish technical issues and safety of endoscopic-assisted burr-hole craniostomy prior to a more comprehensive longer-term outcome study. There is little in the literature that explores the use of endoscopy for the evacuation of chronic SDH.
The treatment of loculated chronic SDH using endoscopic-assisted operative techniques is a minimally invasive method and a potential therapeutic addition or alternative to the standard technique. The application of intracranial endoscopy in neurotraumatology was first considered as a technical principle in the 1980s.3 We aimed to investigate the hypothesis that minimally invasive inspection of haematoma cavities is possible and may potentially enhance the therapeutic intervention of burr-hole drainage of chronic subdural collections. Over a 12-month period, we have used endoscopic assistance with single burr-hole drainage, and prospectively collected data to review the technique.
Section snippets
Materials and methods
The indications for burr-hole craniostomy surgery are beyond the scope of this article; however, all 10 of the initial patients in this study had CT scan findings consistent with either a chronic or subacute subdural collection (Table 1). The authors prefer a single burr-hole technique, with the incision and burr-hole over the subdural collection at its maximal depth. All burr-holes were performed with a high-speed drill, with the diameter of the hole ranging from 20 mm to 35 mm. Following
Results
Over 12 months, a total of 10 procedures were attempted with endoscopic assistance. Subsequent to this, 1 further patient was involved in the study. In 2 patients, conditions were not suitable for the introduction of an endoscope due to inadequate working volume. Eight of the 10 procedures were documented with still picture capture. Six procedures were timed with a mean additional time of 22 min due to endoscopic intervention. There was no additional morbidity throughout the study as a result of
Discussion
Chronic SDHs can be treated operatively via twist drill craniostomy, burr-hole craniostomy or craniotomy. There is an abundance of literature advocating which is the best technique yielding the lowest morbidity and mortality given the clinical picture and radiological findings. Burr-hole treatment is generally accepted as being safer than a craniotomy, and the latter should be reserved for such indications as repeated recurrence of the haematoma, solid consistency of the haematoma, lack of
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Cited by (41)
Neuroendoscopic Technique for Septated Chronic Subdural Hematoma: A Retrospective Study
2024, World NeurosurgeryHistory and current progress of chronic subdural hematoma
2021, Journal of the Neurological SciencesEfficacy of endoscopic treatment for chronic subdural hematoma surgery
2021, Journal of Clinical NeuroscienceCitation Excerpt :Thus, the most effective treatment for these types of CSDH remains controversial. Following the first description of endoscopic treatment for CSDH [10], several studies have reported slight modifications of the technique and established safety management for endoscopic treatment in CSDH surgery [8,11]. Furthermore, endoscopic treatment in CSDH surgery was effective for some types of CSDH including septated CSDH [8] and organized CSDH [12].
Feasibility and Safety of Endoscopic Procedure in Burr-Hole Surgery for Chronic Subdural Hematoma in Patients of Very Advanced Age
2020, World NeurosurgeryCitation Excerpt :In particular, patients of advanced age reportedly have a higher risk of relapse than do younger patients,2,16 and efforts to decrease the risk of recurrence are required. Although the usefulness of endoscopic procedures for CSDH has been reported,17-20 the feasibility of such treatment has not been assessed in patients of advanced age. We previously reported our experience of endoscopic observation within the CSDH cavity.