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J Neurol Surg A Cent Eur Neurosurg 2020; 81(06): 549-554
DOI: 10.1055/s-0040-1715121
Technical Note

Neuroendoscopy-Assisted Evacuation of Chronic Subdural Hematoma with Mixed CT Density Through A Novel Small Bone Flap

Chuan Jun Huang‡   *
1   Department of Neurosurgery, Suzhou Ninth People's Hospital, Soochow, China
,
Xing Liu‡   *
1   Department of Neurosurgery, Suzhou Ninth People's Hospital, Soochow, China
,
Xiao Ting Zhou
2   Department of Central Laboratory, Suzhou Ninth People's Hospital, Soochow, China
,
Wei Qian
1   Department of Neurosurgery, Suzhou Ninth People's Hospital, Soochow, China
,
Chen Hong Li
1   Department of Neurosurgery, Suzhou Ninth People's Hospital, Soochow, China
,
Jin Hui Wang
1   Department of Neurosurgery, Suzhou Ninth People's Hospital, Soochow, China
,
Wei Zhang
1   Department of Neurosurgery, Suzhou Ninth People's Hospital, Soochow, China
,
Yu Zou
1   Department of Neurosurgery, Suzhou Ninth People's Hospital, Soochow, China
› Author Affiliations Funding This work was supported by the Youth Science and Technology Project of Suzhou (KJXW2017075); the Natural Science Research Project of Nantong University (17ZYZ34); and the Scientific Research Project of Suzhou Ninth People's Hospital (201708; 201907).
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Abstract

Objective Chronic subdural hematoma (CSDH) is a common neurosurgical condition with an increasing incidence and favorable prognosis. Surgery is the standard treatment for CSDH, and bur hole evacuation is the most widely employed technique. However, if mixed computed tomography (CT) density is found, burr hole hematoma evacuation is prone to recurrence. Endoscopic examination of the hematoma cavity provides a novel strategy. Here, we present a modification of burr hole evacuation by using neuroendoscopy through a novel small trapezoid bone flap and assess the advantages and risks of the procedure.

Methods Twenty-five patients diagnosed with CSDH of mixed CT density were included in this study. Radiographic, epidemiologic, and clinical data were collected and analyzed. In all procedures the burr hole was replaced by a small trapezoidal cross-sectional bone flap, ∼2 cm in diameter. Neuroendoscopy was employed after the subdural cavity was cleaned and drained. The CSDH cavity was inspected thoroughly. If a blood clot, septa, stretching of cortical vessels, or intraluminal trabecular structures with active bleeding were found, the surgeon aspirated the region with a syringe pipe and/or used bipolar electrocoagulation.

Results All 25 patients who received 26 neuroendoscopy-assisted operations achieved favorable clinical outcomes. The recurrence rate was 4%. The average operation time was slightly increased compared with the traditional burr hole evacuation due to the use of the neuroendoscope and eventual subsequent treatment.

Conclusion Neuroendoscopy provides excellent illumination and vision when a small bone flap is employed. The main advantages of this technique include the precise treatment of structures which are related with progression and recurrence of CSDH, and the minimally invasive nature of the procedure.

Keywords

chronic subdural hematoma - neuroendoscopy - small craniotomy - minimally invasive neurosurgery - trauma

Author Contributions

Zou Yu and Zhang Wei collected the data. Huang Chuanjun and Liu Xing analyzed and interpreted the data and drafted the article. Zhou Xiaoting, Qian Wei, and Li Chenhong revised the manuscript. Zou Yu, Zhang Wei, and Wang Jinhui reviewed the submitted version of the manuscript and approved the final version of the manuscript on behalf of all the authors.


* Huang Chuanjun and Liu Xing contributed equally to the work and should be considered as co-first authors.




Publication History

Received: 20 December 2019

Accepted: 24 March 2020

Article published online:
10 September 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

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