Efficacy of endoscopic treatment for chronic subdural hematoma surgery |
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| Affiliation: | 1. Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, FL, United States;2. Department of Neurological Surgery, The University of Texas at Houston, Houston, TX, United States;3. Center for Clinical Research & Evidence Based Medicine, The University of Texas at Houston, Houston, TX, United States;1. Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India;2. Medical Physics, All India Institute of Medical Sciences, New Delhi, India;1. Department of Neurosurgery, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK;2. Department of Neurosurgery, Southampton General Hospital, Southampton, UK;3. Department of Neurosurgery, University Hospital of Wales, Cardiff, UK;1. Case Western Reserve University School of Medicine, Cleveland, Ohio, USA;2. Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA;3. Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA;4. Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA;5. Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA;6. David Grant Medical Center, Travis Airforce Base, Fairfield, California, USA;7. Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA |
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| Abstract: | Endoscopic treatment is a potential therapeutic addition to chronic subdural hematoma (CSDH) surgery. However, the effect of endoscopic treatment remains controversial. Herein, we examined the optimal indication for endoscopic treatment in CSDH surgery. We retrospectively analyzed 380 consecutive patients with CSDH who underwent single burr-hole craniostomy. We defined postoperative rebleeding as radiological re-accumulation or increased computed tomography value of the hematoma. Reoperation was performed following further hematoma accumulation and/or neurological deterioration. Complicated CSDH was radiologically defined as a hematoma with a clot and/or fibrous septum. There were no differences in baseline characteristics or postoperative mortality and morbidity between the endoscope (97 patients) and control (283 patients) groups. The incidence of postoperative rebleeding (9.3% vs 25.1%, respectively; P = 0.001) and reoperation (0% vs 9.2%, respectively; P = 0.004) were significantly lower in the endoscope group versus controls. Multivariate analysis showed that males (odds ratio 2.14, 95% confidence interval 1.19–3.81; P = 0.012) and endoscopy (odds ratio 0.29, 95% confidence interval 0.13–0.59; P = 0.001) were independently associated with postoperative rebleeding. When CSDHs were divided into two types based on hematoma component, 175 patients exhibited complicated CSDH. There was a significant reduction in postoperative rebleeding (6.5% vs 23.0%, respectively; P = 0.010) and reoperation (0% vs 9.7%, respectively; P = 0.027) in complicated CSDH patients. Endoscopic treatment in CSDH surgery does not increase the risk of surgical complications. Complicated CSDH with a clot and/or septum may be an optimal indication for endoscopic treatment in CSDH surgery to reduce postoperative recurrence. |
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| Keywords: | Endoscopic treatment Chronic subdural hematoma Hematoma clot Fibrous septum Recurrence |
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