Neuroendoscope-assisted Evacuation of Subacute Subdural Hematomas- series of 46 Cases for 10 Years Period

Introduction: Neuroendoscope-assisted evacuation of subacute subdural hematomas (SASDH) currently is not a generally accepted technique of neurosurgical treatment. The aim of our prospective study was to verify the effectiveness of the endoscope-assisted surgery in SASDH.

Methods: The study was based on a preliminary thorough analysis of the relevant literature. Over a period of 10 years (2011-2021), endoscopically-assisted evacuation was performed in 46 cases of SASDH with a layer thickness over than 2,5 cm. The average age in the series was 64 years (range 24 to 85 years) and the male/female distribution was 2/1 (31/15). Burr hole craniotomy and mini craniotomy were performed in a ratio of 3:1 (32:14). Patients were followed-up clinically and radiologically as morbidity, mortality, bleeding and recurrence rates were determined. Glasgow Outcome Scale (GOS) scores were assessed 1 month postoperatively.

Results: The mean operative time in the series was 75 minutes. 34 patients underwent unilateral (L-20 and R-14) and 12 patients bilateral burr hole craniotomy and mini craniotomy. An external subdural drainage was inserted in all procedures for 12-24 hours. Postoperative CT is routinely performed on the first and on the 30th day after the surgery. The bleeding rate was 4,3% (2 cases with hematological disease) and recurrence after 30th day in 8,6% (4 cases). The mortality rate was 6,5 % (3 cases), non-related to procedures, due to heart attack (1 case), thrombocytopenia (1 case) and pulmonary thromboembolism. The average hospital stay was 1 week. The mean GOS score was 4 at 1-month follow-up.

Conclusion : Neuroendoscope-assisted evacuation of SASDH represents safe and effective treatment option. The procedure enables an improved extent of clot removal and examination of the subdural space for actively bleeding vessels. The morbidity, mortality, bleeding and recurrence rates surpass the rates for SASDH evacuation by the conventional method reported in the literature.