Abstract
INTRODUCTION
Chronic subdural hematoma (CSDH) is a common neurosurgical condition encountered by neurologists and neurosurgeons. The incidence appears to be as high as 13.1 cases per 100,000 inhabitants and the peak incidence currently occurs in the eighth decade. The mainstay handling a symptomatic CSDH requires surgical evacuation, copious irrigation of blood clots with possible post operative temporary closed drainage. For decades Twist-drill craniostomy (TDC) and Burr-hole craniostomy played the main roles in the surgical approached with relatively high recurrence rates. It is emphasized that the highest risk for recurrence is seen with a mixed-density and layering type of hematoma on cranial CT and is probably due to the lack of adequate evacuation of the offending effusion due to limited exposure.
METHODS
We assigned 30 consentable adult patients undergoing surgery for presumed subacute/chronic SDH. Included are symptomatic patients with crescent-shaped hypo or isodense hematoma over the cerebral hemisphere, measuring minimal diameter of 10 mm regardless the extent of midline shift. Under general anesthesia traditional BHC approach was used, followed by introduction of 0° rigid endoscope. Using the endoscope guidance we performed thorough inspection of the subdural space, residual clots evacuation, internal membranes fenestration and occasional vessels coagulation. All patients underwent pre and post PT/OT evaluation. Clinical and Radiological follow-up was conducted immediate Post-op, 10 days and 3 months after the procedure. Standardized modified Rankin scale used to evaluate patients recovery.
RESULTS
>Our preliminary results show significantly better clinical and radiological outcome, early recovery and ambulation, fewer recurrence rate and less patients requiring post op drainage. Those findings upon validation can definitely change the traditional way we treat one of the most common neurosurgical conditions.
CONCLUSION
Its speculated that an endoscopically assisted CSDH procedures enables an improved extent of clot removal and release of loculated compartments. Logically, evacuating more of the hyper osmotic content in the subdural space should reduce membranous irritation with the consequent re-bleeding thus recurrence. Under vision control of bleeding source might have a positive impact on infection rate, recurrence rate and patient safety respectivey.