Acute subdural hematomas (aSDH) are one of the most commonly encountered neurosurgical conditions. They occur in approximately 10-20% of all traumatic closed head injuries and represent a significant cause of morbidity and mortality worldwide. Craniotomy for aSDH evacuation is the conventional treatment of choice for patients who require intervention. However, craniotomy for aSDH evacuation may be associated with significant operative blood loss and prolonged recovery time, especially in elderly patients and those with multiple medical comorbidities who are taking antiplatelet or anticoagulant medications. The aim of this single-center, retrospective cohort study is the evaluate the outcomes of minimally invasive endoscopic evacuation of aSDHs.
We retrospectively reviewed the medical records of all patients who underwent minimally invasive endoscopic aSDH evacuation with the Apollo/Artemis neuro-evacuation device (Penumbra, Alameda, CA) at our institution from April 2015 to July 2018.
The study cohort comprised seven patients. Three patients were neurologically intact at presentation, and two presented with dysphasia, one presented with headaches, and one presented with left lower extremity paresis. The median baseline mRS at presentation was 0 (range 0-2). The median degree of hematoma evacuation was 88.4% (range 84.8-95.9%), including median pre- and post-operative hematoma volumes of 51.5 cm3 (range 12.1-91.6 cm3) and 6.6 cm3 (range 0.5-7.9 cm3), respectively. There were no perioperative complications. The discharge status was home in five patients, subacute rehabilitation facility in one, and death in one due to respiratory complications. The median mRS at discharge was 2 (range 0-6).
Minimally invasive endoscopic evacuation of aSDHs using the Apollo/Artemis neuro-evacuation devices affords an acceptable risk to benefit profile, and it could be a reasonable alternative to craniotomy for appropriately selected patients. Further studies are needed to evaluate the long-term outcomes of this approach in larger cohorts.
Craniotomies for evacuation of subdural hematomas can be associated with significant morbidity and mortality. Endoscopic evacuation could be a reasonable alternative to craniotomy in select high risk patients.
By the conclusion of this session, participants should be able to: 1) Understand the morbidity and mortality of acute subdural hematomas 2) Recognize that endoscopic evacuation of acute subdural hematomas is a promising alternative therapeutic intervention
1. Frontera JA, Egorova N, Moskowitz AJ. National trend in prevalence, cost, and discharge disposition after subdural hematoma from 1998-2007. Critical care medicine. Jul 2011;39(7):1619-1625. 2. Rettenmaier LA, Holland MT, Abel TJ. Acute, Nontraumatic Spontaneous Spinal Subdural Hematoma: A Case Report and Systematic Review of the Literature. Case reports in neurological medicine. 2017;2017:2431041. 3. Doherty DL. Posttraumatic cerebral atrophy as a risk factor for delayed acute subdural hemorrhage. Archives of physical medicine and rehabilitation. Jul 1988;69(7):542-544. 4. Balser D, Farooq S, Mehmood T, Reyes M, Samadani U. Actual and projected incidence rates for chronic subdural hematomas in United States Veterans Administration and civilian populations. 2015;123(5):1209-1215. 5. R. EL, Jordan J, Q. LH, et al. Prognosis of Acute Subdural Hematoma in the Elderly: A Systematic Review.0(0):null. 6. Phan K, Moore JM, Griessenauer C, et al. Craniotomy Versus Decompressive Craniectomy for Acute Subdural Hematoma: Systematic Review and Meta-Analysis. World Neurosurgery. 2017/05/01/ 2017;101:677-685.e672. 7. Liu X, Qiu Y, Zhang J, et al. Emergent single burr hole evacuation for traumatic acute subdural hematoma with cerebral herniation:a retrospective cohort comparison analysis. World Neurosurgery. 2018/09/07/ 2018. 8. Karibe H, Hayashi T, Hirano T, Kameyama M, Nakagawa A, Tominaga T. Surgical management of traumatic acute subdural hematoma in adults: a review. Neurol Med Chir (Tokyo). 2014;54(11):887-894. 9. Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of acute subdural hematomas. Neurosurgery. Mar 2006;58(3 Suppl):S16-24; discussion Si-iv. 10. Yokosuka K, Uno M, Matsumura K, et al. Endoscopic hematoma evacuation for acute and subacute subdural hematoma in elderly patients. 2015;123(4):1065-1069. 11. de Oliveira Manoel AL, Goffi A, Zampieri FG, et al. The critical care management of spontaneous intracranial hemorrhage: a contemporary review. Crit Care. Sep 18 2016;20:272. 12. Maruya J, Tamura S, Hasegawa R, Saito A, Nishimaki K, Fujii Y. Endoscopic hematoma evacuation following emergent burr hole surgery for acute subdural hematoma in critical conditions: Technical note. Interdisciplinary Neurosurgery. 2018/06/01/ 2018;12:48-51. 13. Codd PJ, Venteicher AS, Agarwalla PK, Kahle KT, Jho DH. Endoscopic burr hole evacuation of an acute subdural hematoma. Journal of Clinical Neuroscience. 2013/12/01/ 2013;20(12):1751-1753. 14. Matsumoto H, Minami H, Hanayama H, Yoshida Y. Endoscopic Hematoma Evacuation for Acute Subdural Hematoma in the Elderly: A Preliminary Study. Surgical innovation. Jul 1 2018:1553350618785270.