Surgical neurology international最新文献

{"title":"Radiation safety practices in neurosurgery: Exploring education gaps and concerns among physicians and trainees.","authors":"Megan D Malueg, Hayden E Greene, Betsy Grunch, Alexandra R Spath, Renée M Reynolds","doi":"10.25259/SNI_187_2025","DOIUrl":"10.25259/SNI_187_2025","url":null,"abstract":"<p><strong>Background: </strong>In this study, we investigated the adequacy of radiation safety education for neurosurgical trainees and physicians, focusing on their perceptions and concerns.</p><p><strong>Methods: </strong>A survey was distributed through the social media platforms LinkedIn, X (formerly Twitter), and Instagram, as well as through email to individuals listed on the \"2023 Neurosurgery Residency Program Information and Interview Dates\" document available on the Society of Neurological Surgeons website. Surveys were distributed on December 5, 2023, January 18, 2024, and February 8, 2024. The collection of responses ceased on February 26, 2024. Data collected encompassed respondent demographics, practice and training characteristics, radiation safety knowledge and practice, and radiation exposure concerns.</p><p><strong>Results: </strong>Of the 48 total responses received, 25 (women, 22) received from neurosurgical residents, fellows, or attending physicians were analyzed. Concerns about health, fertility, and inadequate radiation safety education were evident. Notably, 68% expressed concerns about the impact of radiation exposure on fertility and 52% on pregnancy, with 60% reporting concerns about health risks of radiation exposure. In addition, 68% found radiation safety education provided throughout their neurosurgical career unsatisfactory, with 44% feeling inadequately informed. Considerable knowledge gaps were demonstrated on assessment.</p><p><strong>Conclusion: </strong>This study reveals prevalent concerns and knowledge gaps in radiation safety education among a geographically diverse group of practicing and training neurosurgeons. Addressing these concerns requires targeted interventions to improve radiation safety education and alleviate apprehensions among neurosurgical trainees and physicians.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"207"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The dark side of the American Association of Neurological Surgeons (AANS): Intimidating Neurosurgeons From Testifying For Patients.","authors":"Nancy E Epstein","doi":"10.25259/SNI_356_2025","DOIUrl":"10.25259/SNI_356_2025","url":null,"abstract":"","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"218"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing precision in aneurysm volume measurement: A comparative study of techniques including an artificial intelligence-based method for endovascular coiling.","authors":"Rafael Trindade Tatit, Carlos Eduardo Baccin, Priya Nair, Emmanuel O Mensah, James Ryan Mason, Seena Dehkharghani, Karen Copeland, Christopher S Ogilvy","doi":"10.25259/SNI_1118_2024","DOIUrl":"10.25259/SNI_1118_2024","url":null,"abstract":"<p><strong>Background: </strong>Durable occlusion after endovascular coiling can be compromised by recanalization, underscoring the need for accurate cerebral aneurysm assessment. Precise volume measurement not only informs treatment decisions and detects subtle aneurysm growth but also refines calculations of packing density, historically linked to occlusion success. This study compares three volume-measurement approaches-traditional two-dimensional (2D) estimation, a semi-automated three-dimensional (3D) technique, and an artificial intelligence (AI)-based 3D method.</p><p><strong>Methods: </strong>In this retrospective analysis, 24 aneurysms were assessed using 3D rotational angiography. Manual segmentation by three specialists using ITK-SNAP or mimics served as the reference standard. These results were compared with volumes from a semi-automated 3D platform (Philips Advanced Visualization Workspace), an AI-based tool (RapidAI for Aneurysm), and traditional 2D estimations. Agreement with the reference standard was quantified through Passing-Bablok regression slopes and mean biases.</p><p><strong>Results: </strong>Passing-Bablok slopes for the 2D, Philips, and RapidAI methods were 0.83, 0.87, and 0.94, respectively, while mean biases were -24.7 mm³ (2D), -19.5 mm³ (Philips), and -14.5 mm³ (RapidAI). RapidAI demonstrated the strongest correlation with the reference standard, whereas 2D estimations showed the largest discrepancy. The semi-automated 3D method exhibited intermediate accuracy, potentially influenced by the clinician input required for segmentation.</p><p><strong>Conclusion: </strong>All methods underestimated aneurysm volumes compared to the reference standard, suggesting that inaccurate volume measurements may mask early aneurysm growth. Among the techniques assessed, the AI-based approach provided the closest agreement with the reference, indicating that improved volumetric methods-particularly AI-driven ones-can enhance early detection of aneurysm expansion, guide treatment decisions, and help establish more reliable follow-up strategies for both treated and conservatively managed aneurysms.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"213"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-endoscopic third ventriculostomy versus ventriculoperitoneal shunting in failed endoscopic third ventriculostomy in pediatric patients with hydrocephalus: A systematic review.","authors":"Ikhlas Ahmed, Usama Choudry, Karim Rizwan Nathani, Abdul Basit, Saad Akhtar Khan, Roua Nasir, Minza Haque, Ahmed Noor, Muhammad Saad Pasha, Aabiya Arif, Naveed Zaman Akhunzada, Oswin Godfrey","doi":"10.25259/SNI_1111_2024","DOIUrl":"10.25259/SNI_1111_2024","url":null,"abstract":"<p><strong>Background: </strong>The objective of this research article is to compare endoscopic treatment versus shunting procedures for failed endoscopic third ventriculostomies (ETVs) in pediatric patients with hydrocephalus.</p><p><strong>Methods: </strong>We did a systematic review based on preferred reporting items for systematic reviews and meta-analyses guidelines on Studies involving pediatric patients (aged 0-18 years) diagnosed with hydrocephalus, reporting on the use of repeat ETV (Re-ETV) or Ventriculoperitoneal shunting (VPS) as a treatment option following failed ETV. Comparative studies, including randomized controlled trials, cohort studies, and any prospective studies, are included. Studies published in the English language conducted between 2001 and 2023 are included.</p><p><strong>Results: </strong>Forty articles were selected for full-text review. Out of which nine articles that clearly addressed the topic of Re-ETV and/or VPS placement after failure of primary ETV were deemed suitable for analysis. A data set of 663 patients was analyzed. Re-ETV was done in 220 patients (33.18%) and VPS Placement was done in 443 patients (66.81%). The primary ETV failure rates ranged from 16.6 to 60.89%. There was a higher failure rate of Re-ETV (74.98%) compared to VPS (22.26%) indicating that VPS is generally more successful as a secondary intervention. The presence of hemorrhage during primary ETV suggested more benefit from VPS placement rather than Re-ETV (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Our systematic review suggests that VPS placement is the more prevalent choice after primary ETV failure, likely due to its higher overall success rate and the nature of complications. The wide variability in failure rates and follow-up durations suggests that treatment outcomes can differ greatly between patients and studies. Decisions regarding secondary interventions should be individualized, considering patient-specific factors such as age, complications, and timing of intervention.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"205"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diffuse midline H3K27-altered glioma in an atypical location mimicking a medulloblastoma.","authors":"Yamila Basilotta Marquez, Juan Medina, Diego Fernando Velasco Sanchez, Romina Argañaraz","doi":"10.25259/SNI_238_2025","DOIUrl":"10.25259/SNI_238_2025","url":null,"abstract":"<p><strong>Background: </strong>Diffuse midline glioma (DMG) with H3 histones in lysine 27 (H3K27) mutation is an aggressive central nervous system tumor that primarily affects children. It often presents with nonspecific neurological symptoms and can mimic other posterior fossa tumors, such as medulloblastoma, on imaging. Due to its poor prognosis and rapid progression, early recognition and accurate diagnosis are crucial for patient management.</p><p><strong>Case description: </strong>We present the case of a 10-year-old girl who developed progressively worsening neurological symptoms, raising suspicion of a posterior fossa tumor. Initial magnetic resonance imaging findings suggested a diagnosis of medulloblastoma. However, after surgical resection, pathological analysis confirmed the presence of a DMG with an H3K27 mutation. Despite the successful resection of a substantial portion of the tumor, the disease progressed rapidly, with tumor dissemination occurring within six months of diagnosis.</p><p><strong>Conclusion: </strong>This case highlights the importance of considering DMG, particularly with H3K27 alterations, as a differential diagnosis in posterior fossa tumors. The presence of these genetic mutations significantly impacts both treatment decisions and prognosis. The variability in clinical presentation and tumor morphology associated with DMG underscores the need for thorough evaluation to optimize treatment strategies and further our understanding of this complex entity.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"215"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative fibrinogen deficiency after surgical removal of intracranial tumors: Prevalence, risk factors and prognosis.","authors":"Firas Kalai, Olfa Faten, Sabrine Ben Brahem, Ichraf Ardhaoui, Lotfi Rebai","doi":"10.25259/SNI_125_2025","DOIUrl":"10.25259/SNI_125_2025","url":null,"abstract":"<p><strong>Background: </strong>Postoperative fibrinogen deficiency after surgical removal of a brain tumor can cause potentially serious complications, such as intracranial hematoma, and worsen the patient's outcome. Our study aimed to determine the prevalence of hypofibrinogenemia after resection of intracranial tumor, to identify the risk factors for this abnormality, and to evaluate the prognosis of patients with this hemostasis disorder.</p><p><strong>Methods: </strong>We conducted a prospective, descriptive study including 120 patients who presented for brain tumor resection without preoperative fibrinogen deficiency and had given their consent to participate in the study. We determined the fibrinogen level the day before the procedure, at 1 h and 24 h postoperatively. We determined the prevalence of postoperative fibrinogen deficiency. Postoperative complications, neurological status of the patient, and mortality at 3 months were subsequently recorded.</p><p><strong>Results: </strong>Forty-eight patients presented postoperative fibrinogen deficiency with a high prevalence of 40%. Our study identified three predictive independent risk factors of fibrinogen deficiency after surgical resection of brain tumor: histological type of meningioma (<i>P</i> = 0.015), prolonged duration of surgery (more than 195 min) (<i>P</i> = 0.045), and use of surgicel as a hemostatic product intraoperatively (<i>P</i> = 0.009). Postoperative hematoma and sensory-motor deficit were significantly associated with postoperative fibrinogen deficiency (<i>P</i> < 0.001). Patients with postoperative hypofibrinogenemia had worse Glasgow Outcome Scale-Extended at discharge and after 3 months. On the other hand, fibrinogen deficiency after surgical removal of the intracranial tumor was not significantly associated with increased postoperative mortality.</p><p><strong>Conclusion: </strong>We found a high prevalence of hypofibrinogenemia after brain tumor resection (40%). This anomaly increases the risk of intracranial hematoma. It, therefore, deserves the attention of the practitioner to correct it rapidly and avoid its potentially serious complications.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"204"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dentato-rubro-thalamic tract tractography: Constrained spherical deconvolution versus diffusion tensor imaging for essential tremor deep brain stimulation targeting.","authors":"Ryan Fernando Menezes, Rafael Lisboa Prudente, Erom Lucas Alves Freitas, Bruno Fernandes de Oliveira Santos","doi":"10.25259/SNI_924_2024","DOIUrl":"10.25259/SNI_924_2024","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to compare diffusion tensor imaging (DTI) and constrained spherical deconvolution (CSD) techniques in the segmentation of the dentate-rubro-thalamic tract (DRTT), evaluating their anatomical accuracy and applicability for surgical planning in deep brain stimulation (DBS) for essential tremor surgery in two patients.</p><p><strong>Methods: </strong>The images were acquired using two 1.5 Tesla magnetic resonance imaging protocols optimized for both DTI and CSD. Preprocessing included noise removal, artifact correction, and distortion adjustments. Segmentation was performed using region-of-interest definitions from specific atlases. CSD was applied with response function estimation, followed by fiber orientation reconstruction and tracking using the probabilistic improved fiber orientation distribution 2(iFOD2) algorithm. The DTI technique was conducted with tensor calculation and fractional anisotropy (FA) analysis. Volume and FA metrics were compared between techniques to evaluate segmentation accuracy for the DRTT.</p><p><strong>Results: </strong>CSD-based segmentation showed significantly larger volumes in the left hemisphere compared to DTI, along with higher FA values. In the right hemisphere, the difference was not statistically significant. Dice similarity index analysis revealed very low correspondence between the techniques in both hemispheres, suggesting greater precision of CSD in DRTT segmentation.</p><p><strong>Conclusion: </strong>CSD proved to be more effective in DRTT segmentation, with better angular resolution and greater detailing of axonal trajectories, especially in regions with fiber crossing.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"211"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual bilateral stimulation of the nucleus accumbens and the centromedian thalamus for treatment of intractable Tourette syndrome.","authors":"Oleksandr Strelko, Maria I Burritt St Angelo, Andrew S Ghannad, Dayna C Sloane, Chloe Verducci, Diego D Luy, Nathan C Pecoraro, Arba Cecia, Joshua E Simon, Jordan C Iordanou, Daryn K Cass, Anand V Germanwala, Douglas E Anderson","doi":"10.25259/SNI_379_2025","DOIUrl":"10.25259/SNI_379_2025","url":null,"abstract":"<p><strong>Background: </strong>Tourette syndrome (TS) is a common neurological disorder characterized by frequent and disabling motor or vocal tics. There has been widely reported variation in patient responses to deep brain stimulation (DBS) for TS treatment. However, the potentially synergistic effects of multifocal DBS placements have not been extensively explored in younger patient populations.</p><p><strong>Case description: </strong>Our patient is a 19-year-old male with a medical history significant for TS and comorbid psychological disorders. Despite medical treatment, the patient's violent tics progressed from simple back extension motor tics to vigorous and aggressive behaviors. He received multiple opinions and trialed numerous pharmacological therapies without success. He was ultimately referred for neurosurgical evaluation for placement of DBS with selected targets of the bilateral nucleus accumbens (NAcc) and bilateral centromedian thalamus for lead implantation. The Yale Global Tic Severity Scale rated by the attending surgeon demonstrated a significant improvement in the patient's baseline tics and overall quality of life from preoperatively to 56 months postoperatively. With multifocal DBS leads in place, the patient's tics are well controlled on a low-moderate dosage of haloperidol. His emotional lability is now reported as less volatile and less extreme. He has become considerably more sociable and talkative.</p><p><strong>Conclusion: </strong>Following DBS placement, the patient experienced substantial improvement from his preoperative violent behavior and mood lability. This case provides evidence that dual electrode DBS, in conjunction with appropriate medical management, is a safe and effective way to improve life quality in individuals struggling with debilitating TS symptoms.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"206"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concomitant trigeminal and glossopharyngeal neuralgia: Illustrative case and scoping review.","authors":"Javier Elizondo-Ramirez, Efrain Roberto Gutierrez-Licona, Katya Elizabeth Unzueta-Villalobos, Christopher J Del Rio-Martinez, Luis Alberto Ordonez-Solorio, Arturo Munoz-Cobos","doi":"10.25259/SNI_202_2025","DOIUrl":"10.25259/SNI_202_2025","url":null,"abstract":"<p><strong>Background: </strong>Cranial neuralgias are characterized by sharp lancinating pain that occurs on specific regions served by cranial nerves. Glossopharyngeal neuralgia (GPN) and trigeminal neuralgia (TN) are disorders for which etiology, epidemiology, and pain regions differ. On the other hand, the treatment stays the same as microvascular decompression, which serves as a safe approach for these entities.</p><p><strong>Methods: </strong>We performed a specific search strategy using the following Boolean terms: (Combined hyperactive dysfunction syndrome) OR (\"Trigeminal\" AND \"Glossopharyngeal\" AND \"neuralgia\") AND (\"Concomitant\" OR \"Combined\" OR \"Simultaneous\" OR \"Concurrent\" OR \"at once\" OR synchronously\"). Including PubMed and Scopus, we found 73 results, of which 10 were included in the study. Furthermore, we did a manual search for one relevant study. The studies were included only if cases with concomitant TN and GPN were present.</p><p><strong>Results: </strong>Fifteen cases were retrieved. The mean age of presentation was 66. About 53.3% of cases were left-sided; the most common etiology was posterior inferior cerebellar artery compression (73.3%). Microvascular decompression is this pathology's most popular management approach (73.3%). Only two cases reported complications (13.3%).</p><p><strong>Conclusion: </strong>The concomitant appearance of TN and GPN is scarce. The microvascular decompression persists as the most popular approach. There are a few treatment modalities used apart from surgical decompression. More research on these areas should be done to generate interest in their application.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"212"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic subdural membranectomy for multi-septated chronic subdural hematoma: Finding a safe solution when middle meningeal artery embolization is not feasible.","authors":"Adnan Hussain Shahid, Mehdi Khaleghi, Sudhir Suggala, Garrett Dyess, Maxon Basett, Danner Warren Butler, Asa Barnett, Ursula Hummel, Danielle Chason, Jai Deep Thakur","doi":"10.25259/SNI_340_2025","DOIUrl":"10.25259/SNI_340_2025","url":null,"abstract":"<p><strong>Background: </strong>Multi-septated chronic subdural hematoma (mCSDH) is a special type of chronic subdural hematoma (CSDH) that is characterized by a hematoma cavity separated by fibrous septa that hinders adequate drainage. Treatment of mCSDH using minimally invasive endoscopic-assisted techniques that may serve as an addition to the standard technique of burr-hole craniotomy drainage. No prior video on the nuances of endoscopic membranectomy (EM) has been described.</p><p><strong>Case description: </strong>In this surgical video, we present the case of an 82-year-old female who presented with symptoms of right-sided body weakness and progressive headaches following a ground-level fall a month prior. Computed tomography (CT) head imaging revealed a subacute CSDH overlying the left frontotemporal and parietal regions, measuring 2.4 cm in maximum diameter, with a 0.9 cm midline shift toward the right side and multiple internal septations. Middle meningeal artery embolization could not be performed due to vascular access limitations. The patient consented to the procedure, and a mini left frontoparietal craniotomy was performed with traditional evacuation of the hematoma. Further, a rigid short endoscope (Karl Storz) with a 0° and 30° high-definition lens was introduced into the subdural space. EM and meticulous septation lysis were performed by microscissors and endoscopic bipolar coagulation along with intermittent irrigation, allowing for the maximal drainage of the subdural hematoma (SDH), hemostasis of friable and bleeding membranes with membranectomy, thereby promoting brain expansion. The duration of surgery was 3.7 h. The patient showed immediate improvement in the postoperative period and was discharged home on postoperative day 3. The interval CT scan at 6 months showed no recurrence. IRB approval was not required per the institutional policy.</p><p><strong>Conclusion: </strong>This video case presentation highlights that EM enhances intra-operative visualization, identification, and division of neo membranes or solid clots under direct vision, helping to prevent recurrence and rebleeding. Judicious use of diluted peroxide, bipolar coagulation, SURGIFLO^®, and fibrin glue effectively controls bleeding. A rigid 30° endoscope aids in visualizing blind spots and bridging vein attachments, ensuring complete SDH evacuation. By adapting techniques over time, we have improved both patient outcomes by minimizing bleeding and operational effectiveness from aggressively peeling membranes off the dura, which could trigger bleeding, to focusing on lysis of unstable, hemorrhagic membranes while preserving thinner, non-bleeding ones. For distant membranous bleeds, SURGIFLO^® and fibrin glue are sufficient, and aggressive lysis in the para-sagittal and parieto-occipital posterior areas is avoided.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"214"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}