Neuroendoscopic Surgery For Complicated Chronic Subdural Hematoma:Technical Points And Efficacy Analysis

Purpose:Chronic subdural hematoma(CSDH)is one of the common diseases in Department of neurosurgery.The elderly and infants are frequent.The annual incidence of the general population is 1/10 million ~3/10 million.However,for people over the age of 75,the age increases by 1 years each year,the incidence rate increases by 7/10 million ~13/10 per year.For complex CSDH treatments,the results are not satisfactory.Based on this,we explored the technical points and clinical effects of minimally invasive neuroendoscopic surgery in the treatment of complex chronic subdural hematoma(CSDH)with high risk factors.Methods:Retrospective analysis on 68 high risk CSDH patients during March 2014 to March 2017 from single center were performed Surgical indications,operative methods,endoscopic technical notes,and clinical therapeutic efficacy of neuroendoscopic surgery were further studied.Results:The surgical indications of neuroendoscopic surgery for high risk patients with complex CSDH were preliminarily established.According to the intraoperative requirements of neuroendoscopic surgery,the relevant surgical instruments were modified,and the corresponding surgical techniques were applied to different complex structures in the hematoma cavity under endoscopic view.The clinical symptoms were significantly improved after endoscopic surgery,and CT scan 24 h post-operation showed that subdural hematoma clearance rate was more than 95%.After 7~24 months of follow-up,2 cases relapsed,of which 1 case was cured after re-endoscopic surgery and 1 patients died of severe pulmonary infection after reoperation.Conclusion: Neuroendoscopic treatment of complicated CSDH with high risk factors showed good curative effect,which can improve the efficiency of hematoma evacuation if combined with surgical instruments,reduce thincidence of postoperative acute bleeding and decerease residual hematoma which often caused recurrence.It provides a new efficient and minimally invasive treatment option for the patients with high risks of performing conventional drilling.