Endoscopically – assisted evacuation of chronic subdural hematoma – new gold standart?

Abstract

Subject: The chronic subdural hematoma is common neurosurgical pathology, which affects mainly the elderly patients. Combining the operative technics with endoscope transforms major part of them into microsurgical. The aim of the conducted study is to affirm the endoscopically – assisted evacuation of chronic subdural hematoma as a routine.
Methods: Based on a thorough analysis of the literature and a period of 10 years. (2011 – 2021) endoscopically -assisted evacuation was performed in 149 patients with chronic subdural hematoma and with a layer thickness of more than 2.5 cm. In all of the cases in the studied series a rigid neuroendoscope with 0 and 30 degree optics was used. Postoperatively, the patients were clinically and radiologically monitored on the first and 30th day, using the GOSE scale and CT of the brain. Morbidity, recurrence and mortality were studied.
Results: All endoscopically-assisted interventions were performed under general anesthesia. The average age of the operated patients is 71 years, and the male / female ratio is 105 / 44, respectively. The average operating time is about 45 minutes for unilateral and 1 hour 15 minutes for bilateral hematomas. The recurrence rate in the series was 10.7% (16 cases). A fatal outcome was recorded in 13 cases (8.7%), and the morbidity related to the operation occurred in one case, and in 3 cases it was related to thromboembolism or hematological diseases. The average GOSE in 24 hours is 4, and in the first month it is 5.
Conclusion: The use of a neuroendoscope in the surgical treatment of SDH reduces the risks of developing complications related to recurrences, morbidity and mortality, and in the future, it may establish itself as the gold standard in the treatment of chronic subdural hematoma.