Slovenská chirurgia 3-4e/2024
Complications in endoscopic-assisted and conventional craniotomic evacuation of intracerebral hematomas
Introduction: Wound healing disorders and surgical field infections are frequent complications after conventional craniotomies. Subgaleal accumulation of fluid usually cerebrospinal fluid can increase the risk of wound dehiscence, cerebrospinal fluid fistula, or infection, especially if there is tension in the skin flap. The risk of complications is increased by a large surgical incision and vascular injuries that can reduce perfusion of the skin flap, leading to ischemia and impaired healing. Monitoring patients in the intensive care unit (ICU) is crucial for early detection of complications such as CSF leaks or infections. Methods: The study retrospectively included patients who underwent conventional craniotomy or endoscopically assisted procedures. Patients with complications continued to be monitored in the ICU, while the length of hospitalization was evaluated in relation to the severity of the complications. Postoperative complications were divided into less severe, which were treated conservatively, and severe, requiring surgical revision. The study compared the number of complications and length of hospitalization between patients undergoing conventional craniotomy and endoscopically assisted procedures. Results: Analysis of postoperative complications showed significant differences between the two surgical methods. The number of patients with conservatively treated complications was significantly higher after conventional craniotomy (24 patients) compared to endoscopic procedures (2 patients) (p = 0.0158). Hematomas and hygromas were noted only in craniotomy patients (p = 0.0120). The total number of complications was higher after craniotomy (p = 0.0001). Conclusion: The results of the study show that endoscopically assisted procedures are associated with a lower number of postoperative complications and shorter hospitalization in the ICU compared to conventional craniotomy. The endoscopic technique offers the advantages of reduced risk of hematomas and faster recovery, making it the preferred method for patients with intracerebral hematomas.
Keywords: convential craniotomy, endoscopically assisted procedures, wound healing
