Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky.
Department of Radiology, University of Louisville School of Medicine, Louisville, Kentucky.
Oper Neurosurg (Hagerstown). 2021 Feb 16;20(3):310-316. doi: 10.1093/ons/opaa390.
Acute subdural hematomas (aSDHs) occur in approximately 10% to 20% of all closed head injury and represent a significant cause of morbidity and mortality in traumatic brain injury patients. Conventional craniotomy is an invasive intervention with the potential for excess blood loss and prolonged postoperative recovery time.
To evaluate the outcomes of minimally invasive endoscopy for evacuation of aSDHs in a pilot feasibility study.
We retrospectively reviewed the records of consecutive patients with aSDHs who underwent surgical treatment at our institution with minimally invasive endoscopy using the Apollo/Artemis Neuro Evacuation Device (Penumbra, Alameda, California) between April 2015 and July 2018.
The study cohort comprised three patients. The Glasgow Coma Scale on admission was 15 for all 3 patients, median preoperative hematoma volume was 49.5 cm3 (range 44-67.8 cm3), median postoperative degree of hematoma evacuation was 88% (range 84%-89%), and median modified Rankin Scale at discharge was 1 (range 0-3).
Endoscopic evacuation of aSDHs can be a safe and effective alternative to craniotomy in appropriately selected patients. Further studies are needed to refine the selection criteria for endoscopic aSDH evacuation and evaluate its long-term outcomes.
急性硬脑膜下血肿（aSDH）约占所有闭合性颅脑损伤的 10%至 20%，是创伤性脑损伤患者发病率和死亡率的重要原因。传统开颅术是一种有创干预措施，有潜在的过度失血和术后恢复时间延长的风险。
在一项初步可行性研究中，评估微创内镜清除 aSDH 的效果。
我们回顾性分析了 2015 年 4 月至 2018 年 7 月期间，我院使用 Apollo/Artemis 神经清除装置（Penumbra，加利福尼亚州阿拉米达）通过微创内镜对连续就诊的 aSDH 患者进行手术治疗的病例记录。
研究队列包括 3 名患者。所有 3 名患者入院时的格拉斯哥昏迷量表评分为 15 分，术前中位血肿量为 49.5cm³（范围 44-67.8cm³），术后中位血肿清除程度为 88%（范围 84%-89%），出院时改良 Rankin 量表评分为 1 分（范围 0-3 分）。
在适当选择的患者中，内镜清除 aSDH 可以作为开颅术的一种安全有效的替代方法。需要进一步研究来细化内镜 aSDH 清除的选择标准，并评估其长期效果。
