J Neurol Surg A Cent Eur Neurosurg 2020; 81(01): 010-016
DOI: 10.1055/s-0039-1685509
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Treatment of Acute Subdural Hematoma with a Normal Small Craniotomy

Sun-Chul Hwang
1  Department of Neurosurgery, Soonchunhyang University, Bucheon Hospital, Bucheon, Gyeonggi, Republic of Korea
,
Dong-Seong Shin
1  Department of Neurosurgery, Soonchunhyang University, Bucheon Hospital, Bucheon, Gyeonggi, Republic of Korea
› Author Affiliations
Further Information

Publication History

12 November 2018

11 January 2019

Publication Date:
04 July 2019 (online)

Abstract

Background Endoscopic surgery is helpful in evacuating intracranial hematomas. However, the indication and the craniotomy location are still unclear in the endoscopic evacuation of acute subdural hematomas (SDHs). This study evaluated the feasibility and efficacy of endoscopic treatment of acute SDH via a normal small craniotomy.

Methods A normal small craniotomy (∼ 3 × 4 cm) as a surgical window was made at the superior temporal line around the coronal suture on the lesion side. A 4-mm rigid endoscope with a 0-degree lens was introduced into the subdural space, and the hematoma was evacuated using irrigation and suction devices with various angles. Endoscopic surgery was performed in 13 older adult patients with acute SDH. Adequacy of the hematoma evacuation, bleeding control, and clinical outcomes were analyzed.

Results The mean age of the patient was 78.6 years (range: 65–89 years). Four cases of cortical arterial bleeding were encountered and controlled with bipolar cauterization. No re-bleeding was observed postoperatively in any patient. Near-total hematoma removal was achieved. Remnant hematoma was scanty and located in the parietal area. No further craniectomy was required after the endoscopic surgery. The outcome at discharge was closely related to the patient's level of consciousness before the operation.

Conclusion A small craniotomy around the superior temporal line provides an optimal window to evacuate an acute SDH and achieve hemostasis using an endoscope. Endoscopic evacuation of acute SDHs could be effective in selected cases.