Turkish Neurosurgery
Neuroendoscopic Technique for Recurrent Chronic Subdural Hematoma with Small Craniotomy
Ichimura Shinya1, Takahara Kento 1, Nakaya Masato1, Yoshida Keisuke1, Fujii Koji1
1Shizuoka City Shimizu Hospital, Neurosurgery, Shizuoka-city,
DOI: 10.5137/1019-5149.JTN.27918-19.4

Aim:The reported rate of recurrent chronic subdural hematoma (rCSDH) is 10%–15% after initial surgery. Herein, we present the endoscopic technique with small craniotomy for rCSDH.Material and Methods:Seventeen patients with rCSDH underwent neuroendoscopic hematoma removal with small craniotomy under local or general anesthesia. The skin incision of the initial surgery on the convexity was extended, and an additional burr hole was made for small craniotomy. After removal of the outer membrane and hematoma under small craniotomy, hematoma was evacuated using a suction tube with the rigid endoscope. The entire circumference of the hematoma cavity was irrigated, while septations and trabeculae in the hematoma were cut. After hematoma evacuation, the inner membrane was cut and removed to allow brain expansion. Postoperative follow-up was performed for at least 6 months.Results:The regrowth rate of rCSDH after performing the neuroendoscopic technique was 5.9%. One patient with rCSDH regrowth underwent neuroendoscopic surgery again, and no re-recurrence was reported for 6 months. Finally, all cases were managed with this neuroendoscopic technique. The postoperative seizure rate was 23.5%.Conclusion:This neuroendoscopic technique could be useful for rCSDH because 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.

Corresponding author : Ichimura Shinya