Endoscopic Evacuation of Acute Subdural Hematomas: A New Selection Criterion

Area of Science:

• Neurosurgery
• Geriatric Medicine
• Minimally Invasive Procedures

Background:

• Acute subdural hematomas (ASDHs) are associated with high mortality and poor outcomes, particularly in the elderly.
• Conventional surgical treatments like craniotomy/craniectomy have limitations in this demographic.
• Advancements in endoscopic techniques offer potential for improved outcomes.

Purpose of the Study:

• To evaluate the efficacy and safety of endoscopic ASDH evacuation (EASE) in elderly patients.
• To explore the correlation between contralateral global cortical atrophy (GCA) and EASE outcomes.
• To compare EASE with traditional surgical methods for ASDH in the elderly.

Main Methods:

• Retrospective analysis of six elderly patients undergoing EASE for ASDH.
• Assessment of demographic data, GCA scores, evacuation rates, and clinical outcomes.
• Statistical analysis of GCA scores and evacuation rates.

Main Results:

• All patients demonstrated improved or stable symptoms and Glasgow Coma Scale scores post-EASE.
• No complications were reported during or after the endoscopic procedures.
• A good outcome was achieved in 66.7% of patients, with higher GCA scores correlating with increased evacuation rates (r=0.825, p≤0.043).

Conclusions:

• EASE is a viable and potentially superior alternative to craniotomy for elderly ASDH patients regarding functional outcomes.
• Contralateral GCA score is a valuable predictor for patient selection for EASE, offering a more nuanced criterion than age alone.