Endoscope-Assisted Keyhole Surgery for Traumatic Subacute Subdural Hematoma Evacuation in Emergencies

OBJECTIVE: This study aimed to investigate whether a simple endoscopic method was effective for the evacua-tion of traumatic subacute subdural hematomas.METHODS: A total of 51 patients with subacute subdural hematomas requiring surgery were enrolled in this study. An endoscopic hematoma evacuation was performed through a small bone window for 22 patients. Hematoma evacuation by open surgery was performed for 29 patients. The postoperative Glasgow Coma Scale scores improve-ment, surgery times, displacement of midline measure-ments, and intraoperative blood loss were recorded and analyzed for each patient.RESULTS: The average time from the initial incision to suture completion was 38.41 +/- 6.97 minutes for the endo-scopic surgery group and 74.66 +/- 9.54 minutes for the open-surgery group (P < 0.01). The average total blood loss was 41.36 +/- 10.82 ml for the endoscopic group and 250.00 +/- 58.25 ml for the open-surgery group (P< 0.01). No postoperative bleeding occurred in either group. The midline displacement measurement showed significant improvement on the day after surgery, with 5.21 +/- 1.98 mm in the study group versus 6.75 +/- 1.37 mm in the control group (P< 0.01). At the 1-month follow-up appointment, the midline measurement was normal in both groups. Computed tomography scans revealed almost no residual hematomas, representing an average evacuation rate of 100% in both groups. The average Glasgow Coma Scale scores improvement on the day after surgery were 1.77 +/- 1.93 in the endoscopic surgery group and 1.66 +/- 0.77 in the open-surgery group (P [ 0.766).CONCLUSION: Endoscopic subacute subdural hema-toma removal through a small bone window achieved satisfactory hematoma removal using a minimally invasive method when compared with an open-surgery method.