Neuroendoscopic Technique for Recurrent Chronic Subdural Hematoma with Small Craniotomy

Özet

AIM: To present a case series describing an endoscopic technique with a small craniotomy for recurrent chronic subdural hematoma(rCSDH) treatment.MATERIAL and METHODS: A total of 17 patients with rCSDH underwent neuroendoscopic hematoma removal with a smallcraniotomy under local or general anesthesia. The skin incision of the initial surgery on the convexity of the skull was extended, anda burr hole was created for a small craniotomy. After the removal of the outer membrane and hematoma through a small craniotomy,the hematoma was evacuated with a suction tube using the rigid endoscope. The entire hematoma cavity circumference wasirrigated, while septations and trabeculae in the hematoma were cut. After hematoma evacuation, the inner membrane was incisedand removed to allow brain expansion. Postoperative follow-up was performed for at least 6 months.RESULTS: The regrowth rate of rCSDH after the neuroendoscopy was 5.9%. One patient with recurrent chronic subdural hematomaregrowth required neuroendoscopy again, but no re-recurrence was observed for the next 6 months. All cases were successfullymanaged using this technique and the postoperative seizure rate was 23.5%.CONCLUSION: This neuroendoscopic technique with a small craniotomy could be useful for recurrent chronic subdural hematomabecause the hematoma and septations can be visualized and evacuated along the entire circumference of the hematoma cavity,and the inner membrane can be torn to allow brain expansion.