Usefulness of computed tomography angiography “spot sign” in the endoscopically assisted evacuation of acute subdural hematoma in the elderly

• Main Authors: Yoshiaki Goto, Takashi Ochi, Yusuke Sakaguchi, Takuya Yoshida, Shigeta Fujitani, Keiichiro Maeda
• Format: Article
• Language: English
• Published: Elsevier 2021-06-01
• Series: Interdisciplinary Neurosurgery
• Subjects: Acute subdural hematoma; Computed tomography angiography; Endoscopic-assisted surgery
• Online Access: http://www.sciencedirect.com/science/article/pii/S2214751921000128

Background: Endoscopic evacuation of acute subdural hematoma (ASDH) is considered useful for elderly patients because of its minimal invasiveness, but there are concerns about insufficient hemostasis during surgery. The purpose of this case series study is to examine whether the spot sign, a point of contrast agent leakage on computed tomography angiography (CTA), would be helpful for sufficient hemostasis during endoscopic-assisted small craniotomy surgery. Methods: The subjects were 11 consecutive ASDH patients who underwent small craniotomy surgery with endoscopic assistance between August 2016 and September 2018. The criteria for surgery were as follows: 1) the presence of symptoms; 2) aged 65 years and older; 3) no severe brain contusion or hematoma 4) not caused by high-energy injury. Preoperatively, we performed CTA for all patients to evaluate the presence of the spot sign.