Endoscopic Intra-Hematomal Evacuation of Intracerebral Hematomas – A Suitable Technique for Patients with Coagulopathies

Orakcioglu, Berk; Uozumi, Yoichi; Unterberg, Andreas

doi:10.1007/978-3-7091-0661-7_1

Cited by 15 publications

(7 citation statements)

References 14 publications

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“…With the rapid advancement of imaging software and transparent tube sheath, endoscopic surgery has gradually become an effective and well-accepted method for treating ICH [9][10][11][12][13]. Endoscopic hematoma evacuation has become well received for its high evacuation rate and less complication, especially in patients with moderatesized hematoma [14].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Surgery Without Decompressive Craniectomy in Large Putaminal Intracerebral Hemorrhage: Assessment of Efficacy and Safety

Wang

et al. 2019

Neurocrit Care

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Background: Decompressive craniectomy (DC) is performed conventionally for large putaminal intracerebral hemorrhage (ICH). However, DC causes local skull defect and leads to post-surgical cranioplasty. The aim of this study is to investigate the effectiveness and safety of an endoscopic procedure to treat large putaminal ICH without DC. Methods: This retrospective study included 112 large putaminal ICH patients who underwent hematoma evacuations with either an endoscopic procedure (group A) or with DC (group B) between January 2009 and June 2017. The efficacy was evaluated by mean modified Rankin Scale (mRS) three months after surgery. Safety was evaluated by mortality rate and postoperative complications. Univariate and multivariate logistic regression analyses were performed to determine the risk factors for clinical outcomes. Results: The study included 49 patients in group A and 63 in group B. The mRS scores in both groups were similar after 3 months' follow-up (p = 0.709). There was no difference in the mortality rate between the two groups (p = 0.538). The rate of complications was lower in group A than that in group B (p = 0.024). Smaller preoperative midline shift (p = 0.008) and absent intraventricular extension (p = 0.044) have contributed significantly to better outcomes. Conclusion: Endoscopic hematoma evacuation without DC is safe and effective for patients with large putaminal ICH and deserves further investigation, preferably in a randomized controlled setting.

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Section: Introductionmentioning

confidence: 99%

Endoscopic Surgery Without Decompressive Craniectomy in Large Putaminal Intracerebral Hemorrhage: Assessment of Efficacy and Safety

Wang

et al. 2019

Neurocrit Care

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“…Similar work has occurred and undergone refinement in China and Japan. [54][55][56][57][58][59][60][61][62][63][64] In total, over 300 subjects have been evaluated with image-guided cannulation of the ICH and the use of thrombolytic drugs. More recently, interest in the use of minimally invasive techniques has increased in response to the early findings of the National Institutes of Health-(NIH-) funded, multisite prospective Minimally Invasive Surgery Plus Rt-PA for ICH Evacuation II (MISTIE II) Trial results that suggest decreased cerebral edema and potential improvement in clinical outcomes.…”

Section: Surgical Managementmentioning

confidence: 99%

Surgical Strategies for Spontaneous Intracerebral Hemorrhage

et al. 2016

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In recent decades, the medical and surgical treatment of intracerebral hemorrhage (ICH) have become the focus of a number of scientific investigations. This effort has been led by an international group of neurologists and neurosurgeons with the goal of studying functional recovery and developing new medical and surgical treatments to facilitate improved clinical outcomes. Currently, two of the most pressing ICH investigational goals are (1) early blood pressure control, and (2) safe hematoma volume reduction. Answering these questions would support decision-making, level-of-care choices, and the global research strategy of developing biologically informed treatments. The authors review the contemporary medical management and the conventional and minimally invasive surgical approaches to spontaneous ICH, as well as discuss the scope of the problem, recent clinical trials, management issues, and relevant questions for future research. They propose the hypothesis that strategies using minimally invasive techniques, including clot aspiration with stereotactic guidance, may give better results with improved clinical outcomes compared with standard open surgical approaches. They also discuss the level of evidence for the variously known approaches.

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“…This group of patients is limited (very rare incidence of neurosurgical complications) and very heterogenous in terms of patients characteristics, type of cardiosurgical procedures, nature of neurological complications and neurosurgical measures taken but the results may support the use of minimally invasive techniques in selected patients with intracerebral haematoma complicating postoperative course after heart surgery. Literature data also support the use of stereotactic haematoma puncture with fibrinolysis (29) or neuroendoscopic treatment in patients with coagulopathies (2,28).…”

Section: Cerebral Ischaemia After Heart Surgerymentioning

confidence: 83%

Neurosurgical treatment of cerebrovascular complications of heart surgeries and interventions

Chrastina

Novák²,

Brichta³

et al. 2014

Turkish Neurosurgery

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AIm: Intracerebral haematoma and brain ischaemia are rare life-threatening complications of cardiovascular surgery. The aim of this study is to present the experience with the neurosurgical treatment of patients with cerebrovascular complications of heart surgery. mATERIAl and mEThods: Patients with brain ischaemia or intracerebral haematoma in the acute phase after heart surgery or invasive intervention operated on between 2002 and 2011 were reviewed. There were 3 patients with middle cerebral artery infarction requiring decompressive craniectomy (2 males, 1 female; mean age 54.3 years) and 5 patients with intracerebral haematoma (3 males, 2 females; mean age 55 years). The type of surgery for intracerebral haematoma was selected individually preferring minimally invasive techniques: stereotactic aspiration (2 patients), neuroendoscopy (1 patient), stereotactic craniotomy (1 patient) or classical craniotomy (1 patient). REsulTs:The results of decompressive craniectomy were unsatisfactory: GOS 1, 3 and 4 in 1 patient each. The results of surgery for intracerebral haematoma were GOS 5 in 1 patient, GOS 4 in 2 patients, and lethal in 2 patients. CoNClusIoN:Minimally invasive neurosurgery techniques appear to be beneficial for selected patients with intracerebral haematoma after heart surgeries even when considering the limited number of patients. Decompressive craniectomy should be considered strictly individually.

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Endoscopic Intra-Hematomal Evacuation of Intracerebral Hematomas – A Suitable Technique for Patients with Coagulopathies

Cited by 15 publications

References 14 publications

Endoscopic Surgery Without Decompressive Craniectomy in Large Putaminal Intracerebral Hemorrhage: Assessment of Efficacy and Safety

Endoscopic Surgery Without Decompressive Craniectomy in Large Putaminal Intracerebral Hemorrhage: Assessment of Efficacy and Safety

Surgical Strategies for Spontaneous Intracerebral Hemorrhage

Neurosurgical treatment of cerebrovascular complications of heart surgeries and interventions

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