Page 155 - EJMO-9-2

Eurasian Journal of
Medicine and Oncology Subdural catheter guidance for CSDH

By precisely guiding the catheter, it enables surgeons to allowing access to hard-to-reach areas that rigid endoscopes
navigate the complex subdural space more accurately, cannot reach. This flexibility, combined with a wider field
thereby reducing the risk of accidental cortical damage. of view, significantly enhances their utility in surgical
However, in clinical practice, surgeons must exercise procedures. For example, in burr hole placement and
extreme caution despite the aid of this advanced guidance CSDH removal, flexible endoscopes play a crucial role. They
device. Catheter insertion remains a crucial step that requires facilitate accurate burr hole placement by providing real-time
close monitoring. Real-time imaging and professional visualization of underlying structures. In CSDH removal,
expertise are essential to ensure the catheter follows the correct they enable surgeons to clearly identify and precisely remove
path while remaining vigilant for any signs of potential venous the hematoma. Overall, their comprehensive view of the
interference, which could lead to bleeding and complicate surgical site enables surgeons to make better decisions,
the procedure. Moreover, ongoing research continues to ultimately improving surgical outcomes and patient safety.
optimize the device’s design and functionality. By exploring However, it is of utmost importance to note that the
new materials and refining guiding mechanisms, the goal is to majority of neuroendoscopic surgeries typically necessitate
further reduce risks and enhance surgical outcomes. general anesthesia. General anesthesia is a multifaceted
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Beyond these aspects, a comprehensive surgical medical intervention involving a complex set of procedures.
risk assessment should be conducted for each patient It begins with the administration of potent medications
before the operation. Factors such as age, overall health that induce unconsciousness, muscle relaxation, and
condition, and the size and location of the hematoma play analgesia in the patient. This process is carefully monitored
significant roles in determining potential risks and the by an anesthesiologist, who continuously assesses the
most appropriate surgical approach. In addition, surgeons patient’s vital signs, including heart rate, blood pressure,
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must undergo specialized training to proficiently operate and oxygen saturation.
the guidance device. This training should not only cover Despite its widespread use, general anesthesia carries
its basic operation but also prepare surgeons to manage inherent risks. One of the most significant concerns is the
various unexpected situations during the procedure. With potential for cardiovascular complications. During general
the widespread application of this technology, establishing anesthesia, the body’s normal physiological responses are
a standardized clinical operation protocol is essential to altered, which can lead to fluctuations in heart rate and
ensure its effective and safe implementation across different blood pressure. In some cases, this can result in more severe
medical institutions. Overall, with its demonstrated ability conditions such as heart arrhythmias, myocardial ischemia,
to enhance surgical safety and its potential for further or even cardiac arrest. In addition, respiratory risks are also a
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improvement, the guidance device holds great promise concern. General anesthesia can suppress the patient’s natural
in CSDH treatment. It may become a standard tool in breathing reflexes, necessitating mechanical ventilation to
neurosurgery, ultimately improving patient outcomes. ensure adequate oxygenation. This can lead to complications
In recent years, many neurosurgeons have advocated such as pneumonia, atelectasis, or respiratory failure.
for endoscopic evacuation of CSDH. This approach has In contrast, the subdural catheter guidance device,
shown particularly promising results in cases of multi- when utilized in conjunction with burr hole and drainage
compartmental subdural hematomas. The ability to directly procedures, often allows the operation to be performed
visualize the internal structure of the hematoma effectively under local anesthesia. This represents a significant
addresses the issue of cortical injury, which is frequently advantage in neurosurgery. Local anesthesia involves
associated with blind catheter insertion, as previously injecting a numbing agent directly into the surgical site,
confirmed by studies. 4,14,23,25 Under endoscopic visualization, blocking nerve signals that transmit pain. This allows
the drainage tube can be positioned with a high degree of the patient to remain conscious during the procedure
accuracy. This precision ensures that the drainage process is while experiencing minimal discomfort. The use of local
highly effective, maximizing the removal of the hematoma anesthesia significantly reduces the risk of anesthesia-
and promoting the restoration of normal intracranial related complications. Since the patient’s vital functions
pressure. 13,19 This is also clearly demonstrated in clinical are not as profoundly affected as they are under general
practice. The endoscope provides real-time guidance anesthesia, the likelihood of cardiovascular and respiratory
during the placement of the drainage tube, allowing for complications are greatly diminished. Moreover, local
optimal positioning to facilitate the smooth drainage of anesthesia eliminates the need for complex intubation
the hematoma (Figure 1E and F). When comparing rigid and ventilation procedures, minimizing the impact on
and flexible endoscopes, flexible endoscopes offer clear the patient’s overall physiological state. This not only
advantages. Their bendable tip provides greater flexibility, reduces immediate surgical risks but also contributes to

Volume 9 Issue 2 (2025) 147 doi: 10.36922/ejmo.8532