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This pilot randomized trial conducted at Government Kilpauk Medical College, Chennai, compared endoscopic membranectomy (EM) with craniotomy and membranectomy (CM) for symptomatic non-homogeneous chronic subdural hematoma. Sixty patients were randomized and followed for six months. No recurrence was observed in either group during follow-up, although two patients in the CM group required reoperation on postoperative day one (P = 0.15). Endoscopic membranectomy was associated with shorter operative time (P = 0.02), less postoperative residual subdural fluid (P = 0.015), improved early radiological indices, less surgical-site swelling (P < 0.001), and shorter hospital stay (P = 0.004). Pain scores and functional recovery were comparable between groups; all patients were ambulant and had a Glasgow Coma Scale score of 15 at discharge and at six months. Conclusion: Endoscopic membranectomy showed promising early radiological and perioperative outcomes, with comparable six-month recurrence and functional recovery in this small trial. Larger multicenter studies are needed before concluding that it is superior to craniotomy.
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This pilot randomized trial conducted at Government Kilpauk Medical College, Chennai, compared endoscopic membranectomy (EM) with craniotomy and membranectomy (CM) for symptomatic non-homogeneous chronic subdural hematoma. Sixty patients were randomized and followed for six months. No recurrence was observed in either group during follow-up, although two patients in the CM group required reoperation on postoperative day one (P = 0.15). Endoscopic membranectomy was associated with shorter operative time (P = 0.02), less postoperative residual subdural fluid (P = 0.015), improved early radiological indices, less surgical-site swelling (P < 0.001), and shorter hospital stay (P = 0.004). Pain scores and functional recovery were comparable between groups; all patients were ambulant and had a Glasgow Coma Scale score of 15 at discharge and at six months. Conclusion: Endoscopic membranectomy showed promising early radiological and perioperative outcomes, with comparable six-month recurrence and functional recovery in this small trial. Larger multicenter studies are needed before concluding that it is superior to craniotomy.
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