{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T08:00:12Z","timestamp":1767772812087,"version":"3.41.0"},"reference-count":7,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\nBackground: <\/jats:title>\nMulti-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.<\/jats:p>\n<\/jats:sec>\n\nCase Description: <\/jats:title>\nIn 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\u00b0 and 30\u00b0 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.<\/jats:p>\n<\/jats:sec>\n\nConclusion: <\/jats:title>\nThis 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\u00ae<\/jats:sup>, and fibrin glue effectively controls bleeding. A rigid 30\u00b0 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\u00ae<\/jats:sup> and fibrin glue are sufficient, and aggressive lysis in the para-sagittal and parieto-occipital posterior areas is avoided.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_340_2025","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T09:52:52Z","timestamp":1748598772000},"page":"214","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Endoscopic subdural membranectomy for multi-septated chronic subdural hematoma: Finding a safe solution when middle meningeal artery embolization is not feasible"],"prefix":"10.25259","volume":"16","author":[{"given":"Adnan Hussain","family":"Shahid","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of South Alabama, Mobile, Alabama, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehdi","family":"Khaleghi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of South Alabama, Mobile, Alabama, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sudhir","family":"Suggala","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Garrett","family":"Dyess","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maxon","family":"Basett","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danner Warren","family":"Butler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asa","family":"Barnett","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ursula","family":"Hummel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danielle","family":"Chason","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jai Deep","family":"Thakur","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2025,5,30]]},"reference":[{"key":"10.25259\/SNI_340_2025\/ref-1","first-page":"1","article-title":"Minimally invasive endoscopic neurosurgery--a survey","volume":"61","author":"Bauer","year":"1994","journal-title":"Acta Neurochir Suppl"},{"key":"10.25259\/SNI_340_2025\/ref-2","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/0090-3019(95)00417-3","article-title":"Endoscopic treatment of septated chronic subdural hematoma","volume":"45","author":"Hellwig","year":"1996","journal-title":"Surg Neurol"},{"key":"10.25259\/SNI_340_2025\/ref-3","first-page":"102","article-title":"Experience using intracranial endoscopy in neurologic traumatology","volume":"140","author":"Karakhan","year":"1988","journal-title":"Vestn Khir Im I I Grek"},{"key":"10.25259\/SNI_340_2025\/ref-4","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.surneu.2006.08.066","article-title":"Membranectomy in organized chronic subdural hematomas: indications and technical notes","volume":"67","author":"Rocchi","year":"2007","journal-title":"Surg Neurol"},{"key":"10.25259\/SNI_340_2025\/ref-5","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/0090-3019(95)00005-4","article-title":"Endoscopic removal of organized chronic subdural hematoma","volume":"43","author":"Rodziewicz","year":"1995","journal-title":"Surg Neurol"},{"key":"10.25259\/SNI_340_2025\/ref-6","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/j.wneu.2017.05.030","article-title":"Membranectomy in chronic subdural hematoma: Meta-analysis","volume":"104","author":"Sahyouni","year":"2017","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_340_2025\/ref-7","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1007\/s10143-023-02007-2","article-title":"Efficacy analysis of neuroendoscopy-assisted burr-hole evacuation for chronic subdural hematoma: A systematic review and meta-analysis","volume":"46","author":"Wu","year":"2023","journal-title":"Neurosurg Rev"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/endoscopic-subdural-membranectomy-for-multi-septated-chronic-subdural-hematoma-finding-a-safe-solution-when-middle-meningeal-artery-embolization-is-not-feasible\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/endoscopic-subdural-membranectomy-for-multi-septated-chronic-subdural-hematoma-finding-a-safe-solution-when-middle-meningeal-artery-embolization-is-not-feasible\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T09:52:53Z","timestamp":1748598773000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/endoscopic-subdural-membranectomy-for-multi-septated-chronic-subdural-hematoma-finding-a-safe-solution-when-middle-meningeal-artery-embolization-is-not-feasible\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,30]]},"references-count":7,"alternative-id":["10.25259\/SNI_340_2025"],"URL":"https:\/\/doi.org\/10.25259\/sni_340_2025","relation":{},"ISSN":["2152-7806","2229-5097"],"issn-type":[{"value":"2152-7806","type":"electronic"},{"value":"2229-5097","type":"print"}],"subject":[],"published":{"date-parts":[[2025,5,30]]},"article-number":"214"}}