A Pilot Study of an Endoscope-Assisted Minimally Invasive Cortical Access System (MICAS) for Chronic Subdural Hematoma Evacuation

OBJECTIVES: Chronic subdural hematoma (CSDH) is a common neurosurgical condition, particularly in the elderly. While traditional surgical options such as craniotomy and burr hole craniostomy remain prevalent, endoscopic evacuation may offer a minimally invasive approach. This study aimed to evaluate the safety and feasibility of a novel device, the Minimally Invasive Cortical Access System (MICAS), with flexible endoscopic evacuation of CSDH. METHODS: A prospective study was conducted from April 2021 to April 2022, enrolling five patients with symptomatic CSDH. Patients underwent endoscopic hematoma evacuation using the MICAS device through a single burr hole. Surgical outcomes and device safety were assessed. RESULTS: The MICAS device was successfully used in all five patients, providing stability and maneuverability for the flexible endoscope. A single burr hole of average size 18.2 ± 6.2 mm was used. In four out of five cases, only one burr hole was used, reducing the need for additional incisions. Subdural drains were placed in four patients. Three patients proceeded to have middle meningeal artery embolization (MMAE). The procedure was well tolerated, without notable direct complications. CONCLUSION: The MICAS device aided in endoscopic evacuation of CSDH, providing safe and effective protection of the cerebral cortex during the flexible endoscopic evacuation. Further studies with a larger sample size are warranted to validate these findings and explore the broader applications of this innovative device.