A single-center experience on endoscopic assisted evacuation of chronic subdural hematoma: is there a role for endoscopic evacuation in the modern era?

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.