MIS burr hole endoscope-assisted evacuation of subacute and chronic subdural haematomas - series of 209 cases
EANS Academy. Arif S. 09/25/19; 275699; EP04112
Shahswar Arif
Shahswar Arif

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Background: Burr hole endoscope-assisted evacuation of subacute and chronic subdural haematomas (SDH) represents a minimally invasive procedure which currently is not a generally accepted technique of neurosurgical treatment. The aim of our prospective study was to verify the effectiveness of the endoscope-assisted minimally invasive surgery (MIS).
Methods: The study was performed based on a preliminary developed protocol and on a thorough analysis of the relevant literature. During the period of 6 years (2012- 2018), burr hole endoscope-assisted evacuation was performed in 209 cases of subacute (42 patients) and chronic (167 patients) subdural haematomas. The average age in the series was 67 years (range 35 to 98 years) and the male/female distribution was 3/1. MIS consists of a linear skin incision, burr hole, dural incision and subsequent endoscope-assisted evacuation. The patients were followed-up clinically and radiologically as morbidity, mortality and rebleeding rates were specified. Glasgow Outcome Scale (GOS) scores were assessed 1 month postoperatively.
Results: The mean operative time in the series was 65 minutes. 172 patients underwent unilateral and 37 patients bilateral burr hole procedures. An external subdural drainage was inserted in all procedures for 24 hours. Postoperative CT-scan was performed routinely on the next day after MIS. The rebleeding rate was 5.8% (12 cases). The mortality rate was 1.4% (3 cases), non-related to MIS, due to heart attack and thrombocytopenia. The surgery-related morbidity was 0.5% (1 case). The average hospital stay was 1 week. The mean GOS score was 4 at 1-month follow-up.
Conclusions: Burr hole endoscope-assisted evacuation of subacute and chronic subdural haematomas (MIS technique) represents safe and effective treatment option. The procedure enables an improved extent of clot removal and release of loculated compartments. The morbidity, mortality, and rebleeding rates surpass the rates for SDH evacuation by the conventional method reported in the literature.
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