LAUSR

Acute subdural hematomas (aSDH) are one of the most commonly encountered neurosurgical conditions, occurring in approximately 10% to 20% of all traumatic brain injuries, and they represent a significant cause of morbidity and mortality. The aim of this retrospective matched cohort study is to compare the outcomes of minimally invasive endoscopy vs craniotomy for evacuation of aSDH. We retrospectively analyzed seven consecutive patients who underwent endoscopic aSDH evacuation at our institution from April 2015 to July 2018. We matched those with respect to age, sex, and hematoma volume using propensity match scoring and included seven patients who underwent craniotomies contemporaneously. We then compared the outcomes of the two matched cohorts. The study cohort comprised seven aSDH patients in each of the matched endoscopy and craniotomy cohorts. The baseline characteristics were comparable between the endoscopy vs craniotomy cohorts, with respect to age (median 50 [21-91] vs 66 [24-78] yr; P = .71), baseline modified Rankin Scale (mRS; median 1 [0-2] vs 2 [0-2]; P = .15), preoperative hematoma volume (median 51.5 [12.1-91.6] vs 28.9 [9-87] cm3; P = .317), maximum preoperative hematoma thickness (mean 11.7 [SD 7.7, 1-27] mm vs 14.9 [SD 3.8, 11-23] mm; P = .052) and amount of midline shift (mean 9.28 [SD 3.35, 6-16] vs 10.28 [SD 5.18, 3-19] mm; P = .74). Significant differences were observed in the baseline GCS at presentation (median 15 [13-15] vs 7 [4-14]; P = .005), The postoperative outcomes were similar between the endoscopy versus craniotomy cohorts, with respect to degree of hematoma evacuation (median 88% [84.8-95.9] vs 90% [85.2-99.2]; P = .654), and follow-up mRS (median 2 [0-6] vs 4 [1-6]; P = .118). No immediate postoperative surgical complications occurred in either cohort. In this preliminary analysis, endoscopic aSDH evacuation afforded adequate evacuation and comparable outcomes to craniotomy. Endoscopy could represent a reasonable alternative to conventional surgery for carefully selected aSDH patients with coagulopathies or extensive medical comorbidities.