title: Endoscopic hematoma evacuation for acute and subacute subdural hematoma in elderly patients.
abstract: OBJECTIVE
  Endoscopic surgery was performed for acute or subacute subdural hematoma (SDH), and its effectiveness and safety in elderly patients were evaluated.
  
  
  METHODS
  Between September 2007 and November 2013, endoscopic surgery was performed in 11 elderly patients with acute SDH (8 patients) and subacute SDH (3 patients). The criteria for surgery were as follows: 1) the presence of clinical symptoms; 2) age older than 70 years; 3) no brain injury (intracerebral hematoma, brain contusion); 4) absence of an enlarging SDH; and 5) no high risk of bleeding. Hematoma evacuation was performed with a 4-mm rigid endoscope with a 0° lens and a malleable irrigation suction cannula.
  
  
  RESULTS
  Endoscopic surgery was performed under local anesthesia. The mean age of the patients was 82.6 years (range 73-91 years). There were 5 female and 6 male patients. The mean preoperative Glasgow Coma Scale score was 12, and 5 patients had been receiving antithrombotic drug therapy. The mean operation time was 85 minutes. Only 1 patient had rebleeding, and reoperation with the same technique was performed uneventfully in this individual. A total of 7 patients had a good recovery (modified Rankin Scale Score 0-2) at discharge.
  
  
  CONCLUSIONS
  Endoscopic hematoma evacuation of acute and subacute SDH is a safe and effective method of clot removal that minimizes operative complications. This technique may be a less invasive method for treating elderly patients with acute and subacute SDHs.
authors.affiliation: Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan.
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Yokosuka
authors.affiliation: Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Uno
authors.affiliation: Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Matsumura
authors.affiliation: Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Takai
authors.affiliation: Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Hagino
authors.affiliation: Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan.
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Matsushita
authors.affiliation: Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Toi
authors.affiliation: Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Matsubara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy; D005260:Female; D020199:Hematoma, Subdural, Acute / Q000601:surgery*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: GCS = Glasgow Coma Scale; SDH = subdural hematoma; acute subdural hematoma; elderly patients; endoscopic hematoma evacuation; mRS = modified Rankin Scale; subacute subdural hematoma; surgical technique