Endoscopic assisted key-hole surgery for subacute subdural hematoma evacuation in emergency situations
Abstract Background Endoscopic removal of subacute subdural hematoma is seldom performed, but there is no standard technique till date. We investigated whether a simple endoscopic method is effective for the evacuation of subacute subdural hematoma. Methods A total of 51 patients with subacute subdural hematoma requiring surgery were enrolled in this study. Endoscopic hematoma evacuation was performed through a small bone window for 22 patients. Hematoma evacuation by open surgery was performed in 29 patients. Pre- and postoperative Glasgow coma scale (GCS), operation time, displacement of midline, and intraoperative blood loss were recorded and analyzed. Results The median time from incision to suture completion was 40 min (range: 31.25–43.75 min) for endoscopic group, and 70 min (range: 65–80 min) for open surgery group (P<0.01). The average total blood loss was 50(30-50) ml for endoscopic group, and 250(200-300) ml for open surgery group (P<0.01). No patient showed post-operative re-bleeding in both groups. The mean preoperative mid-line displacement for the two groups was 11.51±3.51mm for study group vs 10.47±2.93mm for control group (P>0.05). Mid-line displacement showed significant improvement on the day after surgery to 5.29±1.91mm for study group vs 6.75±1.37mm for control group (P<0.01). At 1-month follow-up, the midline was normal in both groups. Computed tomography revealed almost no residual hematoma, representing an average evacuation rate of 100% in both groups. The mean preoperative GCS score was 13(12.25,15) for study group vs 13(12,14) for control group(P>0.05). GCS score on the day after the operation was improved to 15 for each patient in endoscopic surgery group, while 15(14,15)in the open surgery group (P<0.01). Conclusions Endoscopic subacute subdual hematoma removal through a small bone window achieved a satisfactory hematoma removal with minimally invasive method when compared to open surgery.