[Neuro-Endoscopic Surgery for Multi-Lobular Chronic Subdural Hematoma]

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.