Recently, treatment of acute subdural hematoma (ASDH) by minimally invasive surgery with endoscopy has been successfully demonstrated. However, few case series are available on this procedure for ASDH, and the surgical indication has not been established. We retrospectively analyzed the data of patients (n = 26) aged 65 years or older who underwent endoscopic surgery (ES) for ASDH at our institution between January 2011 and March 2019. We then evaluated the surgical outcomes and procedure-related complications in patients who underwent ES. The mean hematoma reduction rate was over 90%. Percentage of favorable outcomes at discharge was 69.2% in ES-treated patients. The presence of a skull fracture, subarachnoid hemorrhage, midline shift/subdural hematoma thickness ratio > 1.0, and early surgery were associated with postoperative IPHs in patients who underwent ES or conventional surgery for ASDH. The present study revealed that ES for elderly patients with ASDH is likely to be an efficient and safe procedure when patients are selected appropriately. However, ES is not recommended in patients with significant IPHs on initial CT scan. Additionally, ES should be carefully considered in cases with the factors, where IPHs may progress following surgery.

中文翻译：

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基于单中心经验的老年外伤性急性硬膜下血肿内镜手术的最佳手术适应证[J].

最近，已经成功地证明了通过内窥镜微创手术治疗急性硬膜下血肿（ASDH）。然而，关于这种 ASDH 手术的病例系列很少，并且手术指征尚未确定。我们回顾性分析了 2011 年 1 月至 2019 年 3 月期间在我们机构接受内窥镜手术 (ES) 治疗 ASDH 的 65 岁或以上患者 (n = 26) 的数据。然后我们评估了以下患者的手术结果和手术相关并发症经历了 ES。平均血肿减少率超过90%。在接受 ES 治疗的患者中，出院时良好结果的百分比为 69.2%。颅骨骨折，蛛网膜下腔出血，中线移位/硬膜下血肿厚度比>1.0，在接受 ES 或常规手术治疗 ASDH 的患者中，早期手术与术后 IPH 相关。本研究表明，如果患者选择得当，ES 对于老年 ASDH 患者可能是一种有效且安全的手术。然而，对于初次 CT 扫描有显着 IPH 的患者，不推荐 ES。此外，如果存在手术后 IPH 可能进展的因素，应仔细考虑 ES。