The neuroendoscopic assisted microsurgical evacuation of chronic subdural hematomas

Abstract

Aim: The primary objective of this study was to emphasize the importance of using neuro-endoscope in the microsurgical evacuating of chronic subdural hematomas with the placement of bur hole(s). Material and Method: The illustrative case was a 67 years old male with one week history of headache. Obtained computed tomography of the head showed the presence of the left frontoparietal chronic subdural hematoma. Results: The patient was operated under general anesthesia. Two burr-holes were placed on the frontal and parietal regions. The chronic subdural hematoma was micro-surgically evacuated after opening of the Dura mater and the parietal membrane of hematoma. After this stage, neuro-endoscopic assistance was used in the obtaining of panoramic view inside the cavity. The presence of hematoma and active bleeding was observed in the cavity. In the other hand the correct placement of drainage catheter was checked by using endoscopic guidance. Discussion: It was concluded that neuro-endoscopic procedure could make microsurgical evacuation of chronic subdural hematoma safer with intraoperative real-time panoramic visualization of the space and may also allow for the identification of active bleeding, septal cavitations, parietal-visceral bridging structures, sediment collections, venous indentations, and catheter position within the cavity.