Management of severe intraoperative hemorrhage during intraventricular neuroendoscopic procedures: the dry field technique

Oertel, Joachim; Linsler, Stefan; Csokonay, Akos; Schroeder, Henry W. S.; Senger, Sebastian

doi:10.3171/2018.4.jns172537

Cited by 24 publications

(18 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another technique is the dry field technique described by Oertel et al, in which the entire CSF is carefully aspirated to better identify the source of bleeding. Furthermore, gravity and air exposure promotes hemostasis [ 27 ]. In addition, large tumor dimensions can also obscure the view, making it difficult for the surgeon to navigate.…”

Section: Discussionmentioning

confidence: 99%

Resection of brain lesions with a neuroendoscopic ultrasonic aspirator — a systematic literature review

et al. 2022

View full text Add to dashboard Cite

The development of minimally invasive neuroendoscopy has advanced in recent years. The introduction of the neuroendoscopic ultrasonic aspirator (NUA) increased the treatment spectrum of neuroendoscopy. This review aimed to present a systematic overview of the extent of resection, lesion characteristics, technical aspects, complications, and clinical outcomes related to using the NUA. Articles were identified by searching the PubMed/Medline, Embase, and Web of Science database through June 2022 with restriction to the last 20 years. We included case series, case reports, clinical trials, controlled clinical trials, meta-analyses, randomized controlled trials, reviews, and systematic reviews written in English. Studies reporting on endonasal approach or hematoma evacuation using the NUA were excluded. The references of the identified studies were reviewed as well. Nine full-text articles were included in the analysis, with a total of 40 patients who underwent surgery for a brain tumor using NUA. The most common underlying pathology treated by NUA was colloid cyst (17.5%), pilocytic astrocytoma (12.5%), subependymal giant cell astrocytoma (7.5%), subependymoma (7.5%), and craniopharyngioma (7.5%). Complete or near-total resection was achieved in 62.5%. The most frequently reported postoperative complication was secondary hydrocephalus (10%), meningitis/-encephalitis (7.5%), cognitive impairment (7.5%), and subdural hygroma (7.5%). In one case (2.5%), surgery-related death occurred due to a severe course of meningoencephalitis. According to the preliminary data, NUA seems to be a safe and efficient minimally invasive alternative to conventional microscopic resection of brain tumors. Further studies to investigate advantages and disadvantages of using the NUA are needed.

show abstract

Section: Discussionmentioning

confidence: 99%

Resection of brain lesions with a neuroendoscopic ultrasonic aspirator — a systematic literature review

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Moreover, with the help of more accurate instruments and neuronavigation methods, endoscopic hematoma evacuation can be conducted under the guidance of visualization of ventricles. Previous reports have shown that patients with IVH treated by endoscopic management tend to have more favorable outcomes, a shorter recovery time[ 3 , 7 , 10 ], and a lower incidence of infection[ 11 ]. Generally, subdural effusion, intraventricular hemorrhage and infection are the main complications in endoscopic procedure, which is similar with conventional indwelling ventricular drainage tube operation.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic surgery for intraventricular hemorrhage: A comparative study and single center surgical experience

Wang¹,

Yuan²,

Li³

et al. 2022

WJCC

View full text Add to dashboard Cite

BACKGROUND Intraventricular hemorrhage is a neurosurgical emergency, and a dangerous condition associated with high morbidity and mortality. Previously, hematoma evacuation is generally executed by external intracranial drainage (EVD) or surgical evacuation. Nowadays, endoscopic evacuation is emerging as a good alternative because it brings relatively less invasion and injury. However, successful endoscopic evacuation requires skilled manipulation of endoscopic devices and the evidence supporting its efficacy differs in different reports. AIM To improve the technique usage and provide more evidence of endoscopic evacuation efficacy, we summarize our surgical experience and compared the outcomes of the endoscopic evacuation with EVD using real-world data. METHODS We retrospectively studied 96 consecutive patients with intraventricular hemorrhage who underwent either endoscopic surgery ( n = 43) or non-endoscopic surgery ( n = 53) for hemorrhage evacuation between November 2013 and September 2019 in our center. Patients’ conditions prior to and after the operation were evaluated and analyzed to assess the efficacy of the operation. The consciousness status improvement and perioperative in-hospital parameters in the two types of operation groups were assessed and compared. RESULTS Patients in the endoscopic and non-endoscopic groups presented with a similar state of consciousness, with a comparable Glasgow Coma Scale (GCS) index. The average operation time of the endoscopic group was longer than that of the non-endoscopic group (median 2.42 h vs 1.08 h, P < 0.001). Although the endoscopic group was older and had a baseline Graeb score that indicated more severe hemorrhage than the non-endoscopic group (Graeb median: Endoscopic group = 9 vs non-endoscopic group = 8, P = 0.023), the clearance rate of hematoma was as high as 60.5%. Both the endoscopic and non-endoscopic groups showed an improved GCS index after surgery. However, this improvement was more marked in patients in the endoscopic group (median improvement of GCS index: Endoscope group = 4 vs non-endoscopic group = 1, P < 0.001). Additionally, the endoscopic group had a lower Graeb score than the non-endoscopic group after the operation. The intensive care unit stay of the endoscopic group was significantly shorter than that of the non-endoscopic group (median: endoscopic group = 6 d vs non-endoscope group = 7 d, P = 0.017). CONCLUSION Endoscopic evacuation of intraventricular hemorrhage was generally an effective and efficient way for hemorrhage evacuation, and contributed remarkably to the improvement of consciousness in patients with intraventricular hemorrhage...

show abstract

“…In endoscopic surgery, vision can be severely restricted even by slight bleeding. Based on our experience and the existing literature, various techniques for hemorrhage control exist, including excessive rinsing, monopolar coagulation, using the heat intensity provided by the light of the endoscope, creating a "fluid chamber" using the trocar or peel-away sheath ("small-chamber irrigation technique"), or using the dry field technique by sucking the CSF out of the ventricles to identify and coagulate the source of bleeding and the air environment also supports the clot formation [19][20][21][22]. These techniques might not suffice for very vascularized lesions compared to microscopic surgery techniques, since forceps for coagulation and adequate suction are not available for neuroendoscopic surgery.…”

Section: Management Of Intraoperative Hemorrhagementioning

confidence: 99%

Endoscopic and Endoscopically-Assisted Resection of Intraventricular Lesions Using a Neuroendoscopic Ultrasonic Aspirator

Ebel

Greuter

Licci

et al. 2021

JCM

View full text Add to dashboard Cite

The development of minimally invasive neuroendoscopy has advanced in recent years. The introduction of the neuroendoscopic ultrasonic aspirator (NUA) broadened the treatment spectrum of neuroendoscopy. We aim to describe our experience with the use of NUA for the resection of intraventricular lesions. Here, we present consecutive retrospective case series of adult and pediatric patients undergoing resection of an intraventricular lesion with a NUA (Endoscopic Neurosurgical Pen, Söring GmbH, Quickborn, Germany) between January 2019 and April 2020. Eight patients between the age of 0.5 and 73 years underwent surgery using NUA and were included in this study. In four patients, an endoscopic assisted (EA) resection of the lesion was undertaken, while in four patients, the lesion was removed using purely endoscopic (PE) resection. In all cases, gross/near total resection was achieved. The average blood loss was 142.5 ± 90.4 mL (range 50–300 mL). Transient morbidity was seen in four patients (50%), while permanent morbidity or mortality did not occur. The NUA seems to be a safe and valuable tool for the minimally invasive resection of intraventricular lesions in selected cases. The type, size, consistency, and vascularization of the lesion limit at times the purely endoscopic use of the NUA.

show abstract

Management of severe intraoperative hemorrhage during intraventricular neuroendoscopic procedures: the dry field technique

Cited by 24 publications

References 18 publications

Resection of brain lesions with a neuroendoscopic ultrasonic aspirator — a systematic literature review

Resection of brain lesions with a neuroendoscopic ultrasonic aspirator — a systematic literature review

Endoscopic surgery for intraventricular hemorrhage: A comparative study and single center surgical experience

Endoscopic and Endoscopically-Assisted Resection of Intraventricular Lesions Using a Neuroendoscopic Ultrasonic Aspirator

Contact Info

Product

Resources

About