CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(02): 153-159
DOI: 10.1055/s-0044-1787101
Research Article

Endoscopic Evacuation of Acute Subdural Hematomas: A New Selection Criterion

1   Department of Neurosurgery, Hospital Pulau Pinang, Penang, Malaysia
2   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
2   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
Yasuhiro Yamada
2   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
Riki Tanaka
2   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
2   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
Takamitsu Tamura
2   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
Yoko Kato
2   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
› Author Affiliations
Funding None.


Introduction Acute subdural hematomas (ASDHs) have a high mortality rate and unfavorable outcomes especially in the elderly population even after surgery is performed. The conventional recommended surgeries by the Brain Trauma Foundation in 2006 were craniotomies or craniectomies for ASDH. As the world population ages, and endoscopic techniques improve, endoscopic surgery should be utilized to improve the outcomes in elderly patients with ASDH.

Materials and Methods This was a single-center retrospective report on our series of six patients that underwent endoscopic ASDH evacuation (EASE). Demographic data, the contralateral global cortical atrophy (GCA) score, evacuation rates, and outcomes were analyzed.

Results All patients' symptoms and Glasgow Coma Scale improved or were similar after EASE with no complications. Good outcome was seen in 4 (66.7%) patients. Patients with poor outcome had initial low Glasgow Coma Scale scores on admission. The higher the contralateral GCA score, the higher the evacuation rate (r = 0.825, p ≤ 0.043). All the patients had a GCA score of ≥7.

Conclusion EASE is at least not inferior to craniotomy for the elderly population in terms of functional outcome for now. Using the contralateral GCA score may help identify suitable patients for this technique instead of just using a cut-off age as a criteria.


The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Publication History

Article published online:
03 June 2024

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