Endoscopic-assisted evacuation of subdural collections.

Treatment of chronic subdural haematoma (SDH) using endoscopic-assisted techniques is a minimally invasive method that may provide an addition to the standard technique of burr-hole craniostomy drainage. Over a 12-month period the authors used endoscopic assistance with burr-hole craniostomy drainage, and prospectively collected data to review the technique. Ten patients were treated during the study, with an average age of 67. Subsequent to the study, one further procedure was performed on a 79-year-old man. Although endoscopic assistance did not alter the intra-operative plan in most patients, it did assist with inserting a subdural catheter for washout of the subdural space, assessing for multi-loculation of the SDH and providing visual images that were captured for discussion with the patient/family and for later study. In one patient, endoscopy assisted with the visualisation and destruction of neomembranes. We conclude that the technique is unlikely to alter the surgeon's pre-operative or intra-operative plan; however, in selected circumstances, it could make the procedure safer with enhanced intra-operative visualization and may also allow for the identification and destruction of neomembranes or solid clots under direct vision.