ArticleSurgical neurology international2025
Endoscopic subdural membranectomy for multi-septated chronic subdural hematoma: Finding a safe solution when middle meningeal artery embolization is not feasible.
Article in Surgical neurology international, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Neuroendoscopic surgery for septated chronic subdural hematoma.Frontiers in surgery · 2025Article
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10 authors.
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Abstract
Background: Multi-septated chronic subdural hematoma (mCSDH) is a special type of chronic subdural hematoma (CSDH) that is characterized by a hematoma cavity separated by fibrous septa that hinders adequate drainage. Treatment of mCSDH using minimally invasive endoscopic-assisted techniques that may serve as an addition to the standard technique of burr-hole craniotomy drainage. No prior video on the nuances of endoscopic membranectomy (EM) has been described. Case Description: In this surgical video, we present the case of an 82-year-old female who presented with symptoms of right-sided body weakness and progressive headaches following a ground-level fall a month prior. Computed tomography (CT) head imaging revealed a subacute CSDH overlying the left frontotemporal and parietal regions, measuring 2.4 cm in maximum diameter, with a 0.9 cm midline shift toward the right side and multiple internal septations. Middle meningeal artery embolization could not be performed due to vascular access limitations. The patient consented to the procedure, and a mini left frontoparietal craniotomy was performed with traditional evacuation of the hematoma. Further, a rigid short endoscope (Karl Storz) with a 0° and 30° high-definition lens was introduced into the subdural space. EM and meticulous septation lysis were performed by microscissors and endoscopic bipolar coagulation along with intermittent irrigation, allowing for the maximal drainage of the subdural hematoma (SDH), hemostasis of friable and bleeding membranes with membranectomy, thereby promoting brain expansion. The duration of surgery was 3.7 h. The patient showed immediate improvement in the postoperative period and was discharged home on postoperative day 3. The interval CT scan at 6 months showed no recurrence. IRB approval was not required per the institutional policy. Conclusion: This video case presentation highlights that EM enhances intra-operative visualization, identification, and division of neo membranes or solid clots under direct vision, helping to prevent recurrence and rebleeding. Judicious use of diluted peroxide, bipolar coagulation, SURGIFLO
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