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Updated: Jul 26, 2025
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Endoscopic Treatment of Chronic Subdural Hematoma Combined with Inner Subdural Hygroma
Yoon Hwan Park1, Kwang-Ryeol Kim1, Ki Hong Kim1
1Department of Neurosurgery, Daegu Catholic University College of Medicine, Daegu, Korea.
Insights
Endoscopic surgery offers a safe and effective treatment for chronic subdural hematoma (CSDH) with inner subdural hygroma (ISH). This minimally invasive approach improves patient outcomes by addressing the fluid collection between the CSDH membrane and the brain.
Area of Science:
- Neurosurgery
- Neurology
- Medical Imaging
Background:
- Chronic subdural hematoma (CSDH) involves bloody fluid collection within the subdural space, encapsulated by neo-membranes.
- Inner subdural hygroma (ISH) is a distinct fluid collection observed between the CSDH's inner membrane and the brain surface.
- The combined presence of CSDH and ISH presents unique diagnostic and therapeutic challenges.
Purpose of the Study:
- To report on six cases of CSDH combined with ISH treated using endoscopic surgery.
- To evaluate the diagnostic accuracy of imaging modalities (CT and MRI) for ISH.
- To assess the safety and efficacy of endoscopic treatment for CSDH with ISH.
Main Methods:
- Six patients with CSDH and ISH were identified and treated between 2011 and 2022.
- Preoperative CT and MRI scans were performed for diagnosis.
- Endoscopic surgery was utilized for hematoma aspiration and membrane fenestration.
Main Results:
- MRI identified ISH in all cases, while CT missed it in two.
- Endoscopic visualization revealed tense, bulging inner membranes due to ISH pressure.
- Post-fenestration and aspiration, membranes subsided, and symptoms improved in all patients.
- One recurrence was noted at 2-month follow-up; no surgery-related complications occurred.
Conclusions:
- CSDH combined with ISH is diagnosable through advanced imaging techniques.
- Endoscopic surgery provides a safe and effective treatment modality for this combined condition.
- Minimally invasive endoscopic fenestration and aspiration alleviate pressure and improve patient outcomes.
Objective:
A chronic subdural hematoma (CSDH) is a collection of bloody fluid located in the subdural space and encapsulated by neo-membranes. An inner subdural hygroma (ISH) is observed between the inner membrane of a CSDH and the brain surface. We present six cases of CSDH combined with ISH treated via endoscopy.
Methods:
Between 2011 and 2022, among the 107 patients diagnosed with CSDH in our institute, six patients were identified as presenting with CSDH combined with ISH and were included in this study. Preoperative computerized tomography (CT) and magnetic resonance imaging (MRI) were performed simultaneously, and endoscopic surgery for aspiration of the hematoma was performed in all cases of CSDH combined with ISH.
Results:
The mean age of patients was 71 years (range, 66 to 79). The patients were all male. In two cases, the ISH was not identified on CT, but was clearly seen on MRI in all patients. The inner membrane of the CSDH was tense and bulging after draining of the CSDH in endoscopic view due to the high pressure of the ISH. After fenestration of the inner membrane of the CSDH and aspiration of the ISH, the membrane was sunken down due to the decreasing pressure of the ISH. There was one recurrence in post-operative 2-month follow up. The symptoms improved in all patients after surgery, and there were no surgery-related complications.
Conclusion:
CSDH combined with ISH can be diagnosed on imaging, and endoscopic surgery facilitates safe and effective treatment.
