Keywords
1. Exoscope-Assisted Surgery
2. Chronic Subdural Hematoma Treatment
3. Minimally Invasive Neurosurgery
4. Recurrent Subdural Hematoma
5. Advanced Neurosurgical Techniques
Introduction
Chronic subdural hematoma (CSDH) is a common neurosurgical condition, especially in the elderly, often resulting from minor head trauma. The standard treatment involves burr-hole irrigation and drainage, which is effective for the majority of patients. Nonetheless, a subset of patients develops refractory cases, with recurrences necessitating additional interventions. This news article explores a pioneering technique reported in the journal “No shinkei geka. Neurological surgery” in April 2019, discussing the employment of an exoscope in conducting a mini-craniotomy for a patient with a recalcitrant CSDH, resulting in successful resolution without further recurrence.
The Innovative Surgical Technique
At Nagasaki University School of Medicine, a team led by Fujimoto Takashi and his colleagues Morofuji Yoichi, Takahira Ryotaro, Gunge Katsuaki, Izumo Tsuyoshi, Kamada Kensaku, and Matsuo Takayuki reported a case where traditional methods for treating CSDH were inadequate. Notably, their patient experienced a recurrence of CSDH three times despite repeated burr-hole irrigation surgeries. Addressing such a complex scenario, the surgeons resorted to employing an exoscope—a high-definition telescopic device designed for performing minimally invasive surgeries. This cutting-edge instrument allowed for greater precision and visibility during the mini-craniotomy, enabling the surgeons to effectively evacuate the hematoma.
Case Overview
The case involved a patient presenting with a disturbance of consciousness and left hemiparesis due to a right-sided CSDH. The computed tomography (CT) scans confirmed the condition, which repeatedly recurred post-operatively after standard treatment. Unwilling to concede to the CSDH’s obstinacy, the surgical team decided to utilize an exoscope for better visualization during a mini-craniotomy. This decision marked a significant deviation from conventional procedures.
The Exoscope: A Technological Leap
The exoscope operates as a mediator between traditional open surgeries and endoscopic techniques. It offers high-definition, magnified views of the surgical field, allowing the surgeon to operate with enhanced precision without the need for large, invasive incisions. The exoscope’s use in neurosurgery is relatively new, but it is gaining traction as surgeons appreciate the improved ergonomics and detailed imagery it provides.
Surgical Procedure
The surgery commenced with a small craniotomy, just large enough to fit the optics of the exoscope and the surgical instruments. Through this minimally invasive approach, the surgeons could clearly view the subdural space and meticulously evacuate the accumulated hematoma. The exoscope’s versatility facilitated maneuverability and enabled the surgeons to address areas that might otherwise be challenging to reach.
Postoperative Course
Postoperatively, the patient showed remarkable improvement without complicating factors. Follow-ups revealed no recurrence of the condition, indicating a successful outcome. The surgical team’s choice to integrate an exoscope into their procedure appeared to be a game-changer, providing a solution where traditional methods had failed.
Discussion
The success of this novel approach in treating refractory CSDH is an exciting development. Traditional procedures, while effective for most patients, may not suffice in challenging cases such as recurrences or thick septated hematomas. The added visualization and dexterity afforded by the exoscope not only improve surgical outcomes but also minimize the potential for complications and intraoperative risks.
Clinical Implications and Future Directions
This case report showcases the potential of advanced surgical technologies like the exoscope in managing difficult cases of CSDH. It paves the way for future research and clinical trials to establish standardized protocols incorporating such devices. It also highlights the importance of individualized patient care, adapting surgical techniques to meet specific clinical needs.
Conclusion
In conclusion, the case report of Fujimoto and colleagues signifies a step forward in neurosurgical interventions for refractory CSDH. Their pioneering use of an exoscope in a mini-craniotomy procedure has shown promise in treating recalcitrant conditions with efficacy and safety. As medical technology continues to advance, it is anticipated that similar minimally invasive techniques will become the norm, offering patients improved outcomes with reduced morbidity.
References
1. Fujimoto Takashi T., Morofuji Yoichi Y., Takahira Ryotaro R., et al. No Shinkei Geka [Surgery for a Refractory Chronic Subdural Hematoma Using an Exoscope: A Technical Case Report]. No Shinkei Geka. Neurological surgery. 2019;47(4):429-434. doi: 10.11477/mf.1436203956.
2. Holl DC, Volovici V, Dirven CMF, et al. Pathophysiology and nonsurgical treatment of chronic subdural hematoma: from past to present to future. World Neurosurg. 2018;116:402-411.e2. doi:10.1016/j.wneu.2018.05.192.
3. Mutoh T, Ishikawa T, Suzuki A, Yasui N. Role of exoscopic neurosurgery in the treatment of pediatric brain tumors: a case series and review of the literature. Childs Nerv Syst. 2019;35(11):2091-2097. doi:10.1007/s00381-019-04347-3.
4. Obermüller T, Schaeffner M, Shiban E, et al. Exoscope or microscope? A microsurgical case series and systematic review of advantages and disadvantages. J Neurosurg Sci. 2020;64(5):398-406. doi:10.23736/S0390-5616.19.04786-5.
5. Singh AK, Suryanarayanan B, Choudhary A, Prasad A, Singh S. A comparative review of the ergonomics and surgeon comfort during endoscopic and microscopic spine surgery. J Craniovertebr Junction Spine. 2018;9(2):81-85. doi:10.4103/jcvjs.JCVJS_38_18.
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