A Novel Imaging Classification System for the Neuroendoscopic Treatment of Chronic Subdural Hematoma

Chronic subdural hematoma (CSDH) is common, especially in patients over 50 years of age, and represents about 10% of all intracranial hematomas. The pathogenesis, diagnosis, and treatment of CSDH are controversial. The purpose of this study was to document the clinical application of a novel imaging classification system for the neuroendoscopic treatment of CSDH. This was a prospective study of sixty patients who underwent neuroendoscopic CSDH treatment beginning in January 2017, with a 6-month follow-up. Hematomas were classified into two types based on imaging features: simple (type I) and complex (type II). Complex type was further subclassified as septated (type II-A), stratified (type II-B), recurrent (type II-C), thin-layer (type II-D), bilateral (type II-E), or mixed (type II-F). Most hematomas were located on the left side. Type II hematomas had fibrous septa and bridging veins in the cavities. Bender classification and Glasgow Outcome Scale (GOS) scores were improved after neuroendoscopic surgery and hematoma thickness was improved significantly in all CSDHs on days 1, 7, and 14 after surgery (all <0.05). Lung infection, pneumocephalus, and seizures occurred in 17, 12, and 8 patients, respectively. Neither a recurrence of symptoms nor CSDH occurred based on the analysis of images. All patients recovered well and none suffered additional bleeding, recurrence, or intracranial infection. This novel imaging classification for CSDH provides a useful guide for the successful neuroendoscopic treatment of CSDH.