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Updated: Oct 20, 2025
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Efficacy of endoscopic treatment for chronic subdural hematoma surgery
Toshiyuki Amano1, Yuichiro Miyamatsu1, Ryosuke Otsuji1
1Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Insights
Endoscopic surgery for chronic subdural hematoma (CSDH) significantly reduces rebleeding and reoperation rates, especially in complicated cases with clots or septa. This approach offers a safe and effective option for CSDH treatment.
Area of Science:
- Neurosurgery
- Minimally Invasive Procedures
- Medical Technology
Background:
- Chronic subdural hematoma (CSDH) management often involves surgical intervention.
- The efficacy of endoscopic techniques in CSDH surgery remains a subject of debate.
- Identifying optimal indications for endoscopic treatment is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of endoscopic treatment in reducing recurrence after CSDH surgery.
- To determine the optimal patient population for endoscopic intervention in CSDH.
- To assess the safety and impact of endoscopic treatment on postoperative complications.
Main Methods:
- Retrospective analysis of 380 CSDH patients undergoing single burr-hole craniostomy.
- Comparison between patients treated with and without endoscopic assistance.
- Definition of postoperative rebleeding and complicated CSDH based on radiological findings.
- Multivariate analysis to identify independent predictors of rebleeding.
Main Results:
- Endoscopic treatment was associated with significantly lower rates of postoperative rebleeding (9.3% vs. 25.1%) and reoperation (0% vs. 9.2%).
- Complicated CSDH cases showed a marked reduction in rebleeding and reoperation with endoscopic intervention.
- Multivariate analysis identified male gender as a risk factor for rebleeding, while endoscopy was protective.
Conclusions:
- Endoscopic treatment is a safe addition to CSDH surgery, without increasing complications.
- Complicated CSDH, characterized by clots or septa, represents an optimal indication for endoscopic treatment.
- Endoscopic intervention can significantly decrease the risk of postoperative recurrence in CSDH patients.
Abstract:
Endoscopic treatment is a potential therapeutic addition to chronic subdural hematoma (CSDH) surgery. However, the effect of endoscopic treatment remains controversial. Herein, we examined the optimal indication for endoscopic treatment in CSDH surgery. We retrospectively analyzed 380 consecutive patients with CSDH who underwent single burr-hole craniostomy. We defined postoperative rebleeding as radiological re-accumulation or increased computed tomography value of the hematoma. Reoperation was performed following further hematoma accumulation and/or neurological deterioration. Complicated CSDH was radiologically defined as a hematoma with a clot and/or fibrous septum. There were no differences in baseline characteristics or postoperative mortality and morbidity between the endoscope (97 patients) and control (283 patients) groups. The incidence of postoperative rebleeding (9.3% vs 25.1%, respectively; P = 0.001) and reoperation (0% vs 9.2%, respectively; P = 0.004) were significantly lower in the endoscope group versus controls. Multivariate analysis showed that males (odds ratio 2.14, 95% confidence interval 1.19-3.81; P = 0.012) and endoscopy (odds ratio 0.29, 95% confidence interval 0.13-0.59; P = 0.001) were independently associated with postoperative rebleeding. When CSDHs were divided into two types based on hematoma component, 175 patients exhibited complicated CSDH. There was a significant reduction in postoperative rebleeding (6.5% vs 23.0%, respectively; P = 0.010) and reoperation (0% vs 9.7%, respectively; P = 0.027) in complicated CSDH patients. Endoscopic treatment in CSDH surgery does not increase the risk of surgical complications. Complicated CSDH with a clot and/or septum may be an optimal indication for endoscopic treatment in CSDH surgery to reduce postoperative recurrence.
