Related Experiment Video
Updated: Feb 25, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
[Neuro-Endoscopic Surgery for Multi-Lobular Chronic Subdural Hematoma]
Toshihito Ishikawa1, Katsuhiro Endo, Yuji Endo
1Department of Neurosurgery, Masu Memorial Hospital.
Insights
Endoscopic evacuation using a rigid endoscope and aspiration tube offers an effective treatment for multi-lobular chronic subdural hematoma (CSDH). This minimally invasive technique resulted in no recurrence and improved neurological function in all treated patients.
Area of Science:
- Neurosurgery
- Minimally Invasive Procedures
- Neurological Surgery
Background:
- Chronic subdural hematoma (CSDH) commonly affects the elderly and is typically managed with burr-hole craniotomy and drainage.
- Recurrent and multi-lobular CSDH present significant treatment challenges, with various surgical options described.
- Previous endoscopic techniques for multi-lobular CSDH have been reported.
Purpose of the Study:
- To evaluate the efficacy of endoscopic evacuation for multi-lobular chronic subdural hematoma (CSDH).
- To compare the outcomes of this endoscopic method with existing literature on CSDH management.
Main Methods:
- Eight patients with multi-lobular CSDH underwent endoscopic evacuation via a small craniotomy (3x3cm).
- The procedure involved longitudinal hematoma evacuation using a rigid endoscope and aspiration tube, preserving the inner membrane.
- Monopolar diathermy was used for bleeding points and capillary networks on the outer membrane.
Main Results:
- The mean surgical duration was 42 minutes.
- Postoperative computed tomography (CT) scans showed no recurrence in any patient.
- All patients experienced improved neurological function after the procedure.
Conclusions:
- Endoscopic evacuation through a small craniotomy is a quick and effective method for draining multi-lobular CSDH.
- The technique demonstrated excellent outcomes with no recurrence and complete neurological recovery in the studied cohort.
- This approach is feasible in facilities with access to CT imaging and rigid endoscopes.
Background:
Chronic subdural hematoma(CSDH)generally occurs in the elderly, and is usually treated by burr-hole craniotomy with closed-system drainage. Treatment of recurrent CSDH is more challenging, especially when the hematoma is multi-lobular. A variety of approaches to the management of multi-lobular CSDH have been described, including evacuation through a wide craniotomy, placement of an Ommaya reservoir, subdural peritoneal shunting, and embolization of the middle meningeal artery. We have previously reported a method of evacuating multi-lobular CSDH through a small craniotomy using a rigid endoscope and aspiration tube. The objective of this study was to compare our operative method with others from the literature.
Materials And Methods:
Between January 2012 and October 2016, eight patients diagnosed with multi-lobular CSDH using computed tomography(CT)imaging underwent endoscopic evacuation. First, we established a 3×3cm craniotomy at a position where a rigid endoscope and aspiration tube would be able to reach as much of the hematoma cavity as possible in the longitudinal plane. Second, after identifying and removing the outer membrane of the CSDH with the scope, we evacuated the hematoma longitudinally, keeping the inner membrane intact. We also applied monopolar diathermy to any obvious bleeding points and the capillary network on the outer membrane of the CSDH, using the aspiration tube.
Result:
The mean duration of surgery was 42 minutes. Follow-up CT scan revealed no recurrence in any of the cases, and neurologic function improved in all patients postoperatively.
Conclusion:
A multi-lobular CSDH can be drained quickly and effectively using a rigid endoscope and aspiration tube through a small craniotomy. In a cohort of eight patients, postoperative neurologic recovery was observed in all cases with no evidence of recurrence. This technique could be used in any facility with ready access to CT imaging and a rigid endoscope.
