Early endoscope-assisted hematoma evacuation in patients with supratentorial intracerebral hemorrhage: case selection, surgical technique, and long-term results

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Currently, the effectiveness of minimally invasive evacuation of intracerebral hemorrhage (ICH) utilizing the endoscopic method is uncertain and the technique is considered investigational. The authors analyzed their experience with this method in terms of case selection, surgical technique, and long-term results.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors performed a retrospective analysis of the clinical and radiographic data obtained in 68 patients treated with endoscope-assisted ICH evacuation. Rebleeding, morbidity, and mortality were recorded as primary end points. Hematoma evacuation rate was calculated by comparing the pre- and postoperative CT scans. Glasgow Coma Scale scores and scores on the extended Glasgow Outcome Scale (GOSE) were recorded at the 6-month postoperative follow-up. The technical aspect of this report explains details of the procedure, the instruments that are used, the methods for hemostasis, and the role of hemostatic agents in the management of intraoperative hemorrhage. The pertinent literature was reviewed and summarized.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>All surgeries were performed within 12 hours of ictus, and 84% of the surgeries were performed within 4 hours. The mortality rate was 5.9%, and surgery-related morbidity occurred in 3 cases (4.4%). The hematoma evacuation rate was 93% overall—96% in the putaminal group, 86% in the thalamic group, and 98% in the subcortical group. The rebleeding rate was 1.5%. The mean operative time was 85 minutes, and the average blood loss was 56 ml. The mean GOSE score was 4.9 at 6-month follow-up. The authors acknowledge the limitations of these preliminary results in a small number of patients.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The data suggest that early endoscope-assisted ICH evacuation is safe and effective in the management of supratentorial ICH. The rebleeding, morbidity, and mortality rates are low compared with rates reported in the literature for the traditional craniotomy method. This study also showed that early and complete evacuation of ICH may lead to improved outcomes in selected patients. However, the safety and efficacy of endoscope-assisted ICH evacuation should be further investigated in a large, prospective, randomized trial.</jats:p></jats:sec>

Keyhole endoscopic hematoma evacuation in patients

“…The last decade has brought significant advances in endoscopic surgical instruments and techniques that have improved patient outcomes (12,16,20). Recent reports on the rate of hematoma evacuation through endoscopic surgery have reached rates of 99% (15,17), and comparative studies about minimally invasive surgery and craniotomy are still rare.…”

“…The published research results by Nagasaka with a combination irrigation-coagulation suction cannula or multifunctional suction cannula showed the rate of good outcome (good recovery and moderate disability) at discharge as 17.3% (4/23), and 0 (0/20) for the craniotomy group (17). Recently Kuo reviewed 68 cases of endoscopic treatment in cerebral hemorrhage with a mortality rate of 5.9%, and surgery-related morbidity of 4.4% (12). In our group, systemic complications, and especially pulmonary infection in addition to the brain-related factors were an important cause leading to death.…”

Comparison between transsylvian-transinsular and transcortical-transtemporal approach for evacuation of intracerebral hematoma

“…Moreover, the blood clots crack in drainage process and release thrombin which may damage brain tissue and influence the recovery of neurological function 20,21 . Furthermore, because of long drainage time and drug injection through drainage tube, the drainage is difficult to care, which may result in an increase in local infection rate of scalp and then the fatal intracranial infection 16 23,24 .…”

Endoscopic surgery of hemorrhagic stroke through the transparent port

“…При возникно-вении даже умеренного кровотечения прозрачность среды резко снижается, ориентирование в полости ВМГ и проведение гемостаза технически затруд-няются. Поэтому кровотечение, которое на этапе удаления гематомы возникает в 30% случаев, может послужить поводом для перехода к открытому вме-шательству [5,6]. Наибольшую плотность сгустки крови достигают на 1-2-е сутки от момента кро-воизлияния.…”

“…Средняя продолжительность хи-рургического вмешательства в основной группе была 138 мин, в контрольной -232 мин. Использование прозрачных портов в эндоскопической хирургии ГИ, по мнению ряда авторов, улучшает исходы хирурги-ческого лечения, снижает летальность, уменьшает продолжительность хирургического вме ша тельства, следствием чего является снижение гнойно-септиче-ских осложнений [6,[8][9][10].…”