Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2022; 10(35): 12920-12927
Published online Dec 16, 2022. doi: 10.12998/wjcc.v10.i35.12920
Efficacy evaluation of neuroendoscopy vs burr hole drainage in the treatment of chronic subdural hematoma: An observational study
Xue-Jian Wang, Yu-Hua Yin, Zhi-Feng Wang, Yi Zhang, Cheng Sun, Zhi-Ming Cui
Xue-Jian Wang, Zhi-Feng Wang, Yi Zhang, 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, Affiliated Hospital 2 to Nantong University, Nantong 226001, Jiangsu Province, China
Author contributions: Wang XJ and Cui ZM conceived of and designed the trial; Wang XJ and Wang ZF collected the data; Sun C and Yin YH and Wang XJ analyzed the data; Wang XJ and Zhang Y wrote the manuscript; All authors contributed to the article and approved the submitted version.
Supported by the Science and Technology Program of Nantong Health Committee, No. MA2019003, No. MA2021017, No. MB2021026, and No. MB2021027; Science and Technology Program of Nantong City, No. Key003 and No. JCZ2022040; and Kangda College of Nanjing Medical University, No. KD2021JYYJYB025.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Affiliate Hospital 2 to Nantong University Institutional Review Board (Approval No. Key03).
Conflict-of-interest statement: The authors declare that there are no conflicts of interest to report.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at 6841441@163.com.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
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. 6 Chongchuan Street, Nantong 226001, Jiangsu Province, China. 6841441@163.com
Received: July 24, 2022
Peer-review started: July 24, 2022
First decision: September 25, 2022
Revised: October 1, 2022
Accepted: November 17, 2022
Article in press: November 17, 2022
Published online: December 16, 2022
Processing time: 143 Days and 2.9 Hours
ARTICLE HIGHLIGHTS
Research background

Chronic subdural hematoma (CSDH) is a common disease in neurosurgery. The traditional treatment methods include burr hole drainage, bone flap craniectomy and other surgical methods. Complications include recurrence, pneumocephalus, infection and so on. With the promotion of neuroendoscopic technology, its treatment effect and advantages need to be further evaluated.

Research motivation

At present, neuroendoscopic technology has been applied in many neurosurgical operations, and it has certain advantages in the treatment of CSDH, which has been gradually carried out in many units. Its treatment effect and advantages need to be further evaluated.

Research objectives

To study the clinical effect of endoscopic small bone approach in CSDH.

Research methods

A total of 122 patients with CSDH admitted to our hospital from August 2018 to August 2021 were randomly divided into two groups using the digital table method: the neuroendoscopy group (n = 61 cases) and the burr hole drainage group (n = 61 cases). The clinical treatment effect of the two groups of patients with CSDH was compared.

Research results

At the early postoperative stage (1 d and 3 d), the proportion of 1/2 re-expansion of the brain tissue in the hematoma cavity and the proportion of complete re-expansion was higher in the neuroendoscopy group than in the burr hole drainage group, and the difference between the two groups was statistically significant (P < 0.05). The recurrence rate of hematoma in the neuroendoscopy group was lower than that in the burr hole drainage group, and the difference between the two groups was statistically significant (P < 0.05). No intracranial hematoma, low cranial pressure, tension pneumocephalus or other complications occurred in the neuroendoscopy group.

Research conclusions

The neuroendoscopic approach for the treatment of CSDH can clear the hematoma under direct vision and separate the mucosal lace-up. The surgical effect is apparent with few complications and definite curative effect, which is worthy of clinical promotion and application.

Research perspectives

This is a 4-year case study at a single center. The number of cases was small, but we were satisfied with the results of this study, which gives us the confidence to carry out further research studying the corresponding technology, summarizing the indications better and providing support for better clinical work. In the next step, we will apply for further multicenter studies.