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Updated: Oct 4, 2025
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Endoscopic evacuation of septated chronic subdural hemorrhage - Technical considerations, results, and outcome
Harnarayan Singh1, Rana Patir2, Sandeep Vaishya2
1Department of Neurosurgery, Narayana Super Speciality Hospital, Gurugram, Haryana, India.
Insights
Endoscopic evacuation of septated chronic subdural hematoma (sCSDH) offers a safe and effective surgical approach. This technique improves clot removal and membrane excision, reducing recurrence rates compared to traditional methods.
Area of Science:
- Neurosurgery
- Minimally Invasive Procedures
Background:
- Septated chronic subdural hematoma (sCSDH) management is challenging due to neomembranes.
- Traditional burr hole irrigation is less effective for sCSDH, leading to potential recurrence.
Purpose of the Study:
- To evaluate the efficacy and safety of endoscopic evacuation for sCSDH.
- To assess the technique's ability to improve clot removal and reduce recurrence.
Main Methods:
- Minicraniotomy (2.5 cm × 2.5 cm) with rigid endoscope-assisted visualization.
- Neomembrane removal using standard neurosurgical microinstruments under direct vision.
- Irrigation and hemostasis achieved under endoscopic guidance.
Main Results:
- 83 procedures performed in 68 patients (Jan 2016 - Apr 2020).
- Low recurrence rate: only 1 patient (1.47%) experienced significant re-bleeding.
- Mean follow-up of 25.3 months showed no significant recollection in remaining patients.
Conclusions:
- Endoscopic evacuation is a safe and effective treatment for sCSDH.
- Direct visualization allows for complete clot and membrane removal, minimizing recurrence.
- This minimally invasive approach avoids the need for larger craniotomies.
Background:
Chronic subdural hematoma (cSDH) is a common entity in the elderly. Homogeneous or well-liquefied CSDH has a standard line of treatment through burr hole and irrigation. However, the management of septated chronic subdural hematoma (sCSDH) with multiple membranes does not have a well-defined surgical approach. The neomembranes forming septations prevent evacuation of clots through burr holes, and the small remaining loculi with clots will enlarge overtime to cause recurrence.
Methods:
Patients with sCSDH were operated through a minicraniotomy (2.5 cm × 2.5 cm) using rigid endoscopes for visualization of the subdural space. Using endoscope, the entire subdural space can be visualized. The neomembranes are removed with standard neurosurgical microinstruments. The entire cavity is irrigated under vision to remove all clots and ensures hemostasis.
Results:
Eighty-three endoscope-assisted evacuations were done in 68 patients from January 2016 to April 2020. Fifty (73.5%) patients had unilateral and 18 (26.5%) had bilateral subdural. Only 1 patient (1.47%) had a clinically significant recollection of subdural bleeding 1 month after the procedure. Over a mean follow-up period of 25.3 months (range 1-53 months), rest of patients did not show any recollection.
Conclusion:
Endoscopic evacuation of sCSDH is a safe and effective method and can be used to improve clot evacuation, and remove neomembranes under direct vision to reduce the rates of recollection. This method also obviates the need for larger craniotomies to remove membranes.
