Endoscopic Management of Chronic Subdural Hematoma Using a Novel Brain Retractor

Area of Science:

• Neurosurgery
• Minimally Invasive Procedures

Background:

• Chronic subdural hematoma (CSH) management can be challenging with complex cavity features.
• Rigid endoscopy faces limitations in visualizing large, curved CSH cavities due to brain surface obstruction.

Purpose of the Study:

• To evaluate the efficacy and safety of endoscopic techniques combined with a brain retractor for CSH management.
• To assess the feasibility of avoiding craniotomy in complex CSH cases.

Main Methods:

• Retrospective study of 248 patients undergoing endoscopic CSH evacuation.
• Literature review of relevant endoscopic management techniques for CSH.

Main Results:

• The combined approach demonstrated an average operative time of 56 minutes, 3.1 days of drainage, and 4.6 days of hospital stay.
• Significant improvement in Glasgow Coma Scale (GCS) scores was observed post-operatively.
• Successful management of complex CSH features including solid clots (51%), septations (52%), and curved cavities (49%) was achieved.

Conclusions:

• Endoscopic procedures are highly effective and safe for CSH, particularly in cases with septations, solid clots, and bridging vessels.
• The integration of a brain retractor enhances visualization, enabling complete hematoma removal in challenging cases.
• This endoscopic approach offers a viable alternative to craniotomy for specific CSH patient populations.