Ben-Shalom Netanel, Ferreira Marcio Yuri, Feghali James, Orlev Alon, Levitan Idan, Sapirstain Eilat, Harnof Sagi, Ben-David Uzi
Department of Neurosurgery, Northwell, New Hyde Park, NY, USA.
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Neurosurg Rev. 2025 Sep 18;48(1):652. doi: 10.1007/s10143-025-03815-4.
Despite numerous randomized clinical trials (RCTs) published in recent years and the development of consensus guidelines, there is still room for refinement in treatment indications aimed at lowering recurrence rates and optimizing surgical and clinical outcomes in chronic subdural hematoma (cSDH). Herein, we report our single-center outcomes on endoscopic assisted evacuation of cSDH. We retrospectively assessed the patient charts for baseline characteristics and surgical and clinical outcomes of all consecutive patients who underwent endoscopic evacuation of cSDH during the period of January 2016 and January 2017. Endpoints assessed were postoperative hematoma size, difference between preoperative and postoperative hematoma size, postoperative midline shift, difference in incidence of preoperative and postoperative midline shift, mRS (modified Rankin Scale) at discharge, Glasgow outcome scale (GOS) at discharge, 30-day total complications, 30-day major complication, 30- day minor complication, reoperation, hematoma size at last follow up (FU), difference between last-FU hematoma size and preoperative hematoma size, 6-month mRS, incidence of worst mRS at last-FU in comparison to preoperative mRS, and procedure-related mortality. Fourty-four patients with a mean age of 74.5 ± 13.6 years, of which 16 (36%) were females, were included. The mean hospital LOS was 3.9 ± 2.4 days. Surgery achieved an average decrease in hematoma size and midline shift of 12.0 ± 4.4 mm and 5.2 ± 2.8 mm, respectively. The total 30-day complication rate was 36% with a major complication rate of 14%. The most frequent complication was seizure (31% of complications). There was one procedure-related mortality (2%). On discharge, most patients (29/44, 66%) had a good mRS score (0-2). A total of 4 (9%) patients required reoperation. Favorable 6-month GOS (4-5) and mRS (0-2) occurred in 31 (78%) and 35 (84%) patients, respectively. Compared to pre-operative functional status, 6-month mRS was worse only in 4 (10%) patients. In our single-center experience, including most patients with cSDH with membranes and mixed density hematomas, EAE was highly effective and safe. In the modern era, MMAE has proven to be effective as adjunctive to surgical evacuation in cSDH, and we believe that RCTs comparing EAE combined with MMAE to other surgical modalities.
尽管近年来发表了大量随机临床试验（RCT）并制定了共识指南，但在旨在降低慢性硬膜下血肿（cSDH）复发率并优化手术和临床结果的治疗指征方面仍有改进空间。在此，我们报告我们单中心内镜辅助清除cSDH的结果。我们回顾性评估了2016年1月至2017年1月期间所有连续接受cSDH内镜清除术患者的病历，以获取基线特征以及手术和临床结果。评估的终点包括术后血肿大小、术前与术后血肿大小的差异、术后中线移位、术前与术后中线移位发生率的差异、出院时的改良Rankin量表（mRS）、出院时的格拉斯哥预后量表（GOS）、30天总并发症、30天主要并发症、30天次要并发症、再次手术、末次随访（FU）时的血肿大小、末次随访时血肿大小与术前血肿大小的差异、6个月时的mRS、末次随访时最差mRS与术前mRS相比的发生率以及与手术相关的死亡率。纳入了44例平均年龄为74.5±13.6岁的患者，其中16例（36%）为女性。平均住院时间为3.9±2.4天。手术使血肿大小平均减少12.0±4.4mm，中线移位平均减少5.2±2.8mm。30天总并发症发生率为36%，主要并发症发生率为14%。最常见的并发症是癫痫（占并发症的31%）。有1例与手术相关的死亡（2%）。出院时，大多数患者（29/44，66%）的mRS评分良好（0 - 2分）。共有4例（9%）患者需要再次手术。31例（78%）患者6个月时GOS良好（4 - 5分），35例（84%）患者6个月时mRS良好（0 - 2分）。与术前功能状态相比，仅4例（10%）患者6个月时mRS变差。根据我们单中心的经验，包括大多数伴有包膜和混合密度血肿的cSDH患者，内镜辅助清除术（EAE）高效且安全。在现代，微创血肿清除术（MMAE）已被证明作为cSDH手术清除的辅助手段是有效的，并且我们认为需要进行RCT来比较EAE联合MMAE与其他手术方式。
