Endoscope-Assisted Manipulation of Chronic Subdural Hematoma Provide a Novel Solution for Eliminating Septum and Inner Membrane Leading to Reducing Recurrence

Abstract

Abstract OBJECTIVE: The canonical burr-hole craniostomy with drainage (BHC-D) has been main treatment for the chronic subdural hematoma. However, complicated situation such as organized clot or compartmentation may mandate the recurrent chronic subdural hematoma (CSDH). Our team has introduced a novel technique applying the endoscope for tearing inner membrane and septum in addition to evacuating the hematoma in the subdural space where the in-line visualization not being accessed. The novel concept of practice may provide a clinical value with optimizing the future recurrence. MATERIALS and METHODS: Two hundred and twenty-nine cases of CSDH were enrolled and analyzed. Among them, 13 were endoscopically treated and the surgery details were recorded. The 0- degree and 30-degree, 2.7 mm endoscope (Storze, Turlington, Germany) were applied after a BHC. The arachnoid knife for microsurgery is utilized for tearing the inner membrane to open up the compartments. The demographic data including comorbidities, surgical parameters and follow up of images were evaluated. RESULTS: Compared with non-endoscope-assisted operated patients (non-Endo group), the 13 endoscope-assisted membranectomy (EM) patients (Endo group) demonstrated no difference with regard to gender, age, body mass index (BMI), trauma and other diseases, or use of anticoagulation agent. Although the surgery time spent for the Endo patients were longer (128.53 ± 49.56 min) than non-Endo group (65.18 ± 32.89 min), intriguing, no recurrence was found among Endo group, while high to 6.5% happened among the non-Endo patients in outpatient follow-up. CONCLUSION: Our proposed endoscope-assisted membranectomy (EM) has provided a practical technique aiming to reduce recurrence and optimize the surgical outcome.