Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 16, 2023; 11(14): 3204-3210
Published online May 16, 2023. doi: 10.12998/wjcc.v11.i14.3204
Positioning and design by computed tomography imaging in neuroendoscopic surgery of patients with chronic subdural hematoma
Xue-Jian Wang, Yu-Hua Yin, Long-Yao Zhang, Zhi-Feng Wang, Cheng Sun, Zhi-Ming Cui
Xue-Jian Wang, Long-Yao Zhang, Zhi-Feng Wang, Department of Neurosurgery, Affiliated Hospital 2 to Nantong University, Nantong 226001, Jiangsu Province, China
Yu-Hua Yin, Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University, Shanghai 200000, China
Cheng Sun, Jiangsu Provincial Key Laboratory of Nerve Regeneration, Nantong University, Nantong 226001, Jiangsu Province, China
Zhi-Ming Cui, Department of Orthopedic, Affiliate Hospital 2 to Nantong University, Nantong 226001, Jiangsu Province, China
Author contributions: Wang XJ and Yin YH conceived and designed the trial; Wang XJ and Wang ZF collected the date; Sun C and Cui ZM analyzed the date; Wang XJ and Zhang LY wrote the manuscript; and all authors contributed to the article and approved the submitted version.
Institutional review board statement: This research has been approved by the ethics committee of our department.
Informed consent statement: Informed consent has been obtained and this investigation has been conducted according to the principles expressed in the Declaration of Helsinki. And the authors have obtained written informed consent of all the patients.
Conflict-of-interest statement: All the authors have no any conflict-of-interest statement.
Data sharing statement: All data is saved by corresponding author. If you need relevant information, you can contact corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xue-Jian Wang, MD, PhD, Professor, Surgeon, Department of Neurosurgery, Affiliated Hospital 2 to Nantong University, No. 666 Shengli Road, Chongchuan District, Nantong 226001, Jiangsu Province, China. 6841441@163.com
Received: December 9, 2022
Peer-review started: December 9, 2022
First decision: March 10, 2023
Revised: March 22, 2023
Accepted: April 6, 2023
Article in press: April 6, 2023
Published online: May 16, 2023
Processing time: 150 Days and 21.2 Hours
Abstract
BACKGROUND

Neuroendoscopy is a very useful technique to Chronic Subdural Hematoma (CSH). But how to achieve the goal of treatment more minimally invasive?

AIM

To develop a simple, fast and accurate preoperative planning method in our way for endoscopic surgery of patients with CSH.

METHODS

From June 2018 to May 2020, forty-two patients with CSH, admitted to our hospital, were performed endoscopic minimally invasive surgery; computed tomography (CT) imaging was employed to locate the intracerebral hematoma and select the appropriate endoscopic approach before the endoscopic surgery. The clinical data and treatment efficacy were analyzed.

RESULTS

According to the learning of CT scanning images, the surgeon can accurately design the best minimally invasive neuroendoscopic surgical approach and realize the precise positioning and design of the drilling site of the skull and the size of the bone window, so as to provide the most effective operation space with the smallest bone window. In this group, the average operation time was only about 1 h, and the clearance rate of hematoma was about 95%.

CONCLUSION

Patients with CSH can achieve good therapeutic effect by using our way to positioning and design to assist the operation of CSH according to CT scan and image, and our way is very useful and necessary.

Keywords: Chronic subdural hematoma, Neurosurgery neuroendoscopy, Positioning and design, Bone window design

Core Tip: Via minimally invasive neuroendoscopic surgery, one can use smaller surgical incisions and bone windows to achieve effective removal of intracranial hematoma, minimal trauma to brain tissue, and effective reduction of recurrence rate. However, due to variations in hematoma site, shape, size and degree of clots, the location of bone hole and approaches for minimally invasive endoscopy are also different for each patient. How to accurately locate the intracerebral hematoma in chronic subdural hematoma (cSDH) patients before surgery and design an individualized approach for minimally invasive endoscopy is one of the keys to success. To better treat cSDH patients using minimally invasive neuroendoscopy, we use computed tomography scanning to locate cSDH and select the best endoscopic micro-mirror approach before performing minimally invasive neuroendoscopic surgery and analyzed the clinical data and treatment efficacy.