Image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage (original) (raw)
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Stroke, 2016
Background and Purpose— Intracerebral hemorrhage (ICH) is a devastating disease without a proven therapy to improve long-term outcome. Considerable controversy about the role of surgery remains. Minimally invasive endoscopic surgery for ICH offers the potential of improved neurological outcome. Methods— We tested the hypothesis that intraoperative computerized tomographic image–guided endoscopic surgery is safe and effectively removes the majority of the hematoma rapidly. A prospective randomized controlled study was performed on 20 subjects (14 surgical and 4 medical) with primary ICH of >20 mL volume within 48 hours of ICH onset. We prospectively used a contemporaneous medical control cohort (n=36) from the MISTIE trial (Minimally Invasive Surgery and r-tPA for ICH Evacuation). We evaluated surgical safety and neurological outcomes at 6 months and 1 year. Results— The intraoperative computerized tomographic image–guided endoscopic surgery procedure resulted in immediate reducti...
Stroke, 2021
Background and Purpose: We present a retrospective analysis of patients who underwent minimally invasive endoscopic intracerebral hemorrhage (ICH) evacuation to identify variables that were associated with long-term outcome. Methods: Minimally invasive endoscopic ICH evacuation was performed on patients with supratentorial ICH who fit prespecified clinical inclusion and exclusion criteria. Demographic, clinical, and radiographic factors previously demonstrated to impact functional outcome in ICH were included in a univariate analysis to identify factors associated with favorable outcome (modified Rankin Scale score, 0–3) at 6 months. Factors associated with a favorable outcome in the univariate analysis ( P ≤0.20) were included in a multivariate logistic regression analysis with the same dependent variable. Results: Ninety patients underwent MIS endoscopic ICH evacuation within 72 hours of ictus. In a multivariate analysis, factors associated with good long-term functional outcome i...
Endoscopic hematoma evacuation in patients with spontaneous supratentorial intracerebral hemorrhage
Journal of the Chinese Medical Association, 2014
Background: Surgical evacuation of spontaneous supratentorial intracerebral hemorrhage (ICH) is controversial because the traditional surgical approach sometimes causes further brain injury. The introduction of the neuroendoscope has brought with it the new idea of minimal invasiveness, which may improve the surgical results of ICH. Methods: Twenty-one patients with spontaneous supratentorial ICH underwent endoscopic hematoma evacuation between December 2010 and January 2012. Safe entry points could be Kocher's, Keen's, or Frazier's point, depending on the locations of the hemorrhages. The surgical steps were as follows: (1) cortical incision and dilation of the channel; (2) introduction of the transparent sheath; (3) gushing out of the hematoma under high intracranial pressure; (4) changing the angle of the transparent sheath, endoscope, and suction tip to remove residual hematoma; and (5) paving a layer of hemostatic agents after hematoma removal. Results: The median operative time was 120 minutes (range: 90e190 minutes), and the median blood loss was 160 mL (range: 50e300 mL). The median duration of intensive care unit stay was 6 days (range: 2e18 days). The median hematoma evacuation ratio was 90% (range: 60e99%). Two patients had rebleeding events, and the mortality rate was 9.5% (n ¼ 2/21). The median Glasgow Coma Scale score improved from 8 to 11 within 1 week after surgery, and the median Glasgow Outcome Scale score was 3 after 6 months and 12 months follow-up. Conclusion: With the introduction of the minimally invasive techniques and the evolution of the neuroendoscope and hemostatic agents, the median operative time and blood loss have been significantly decreased. Although the hematoma evacuation rates were similar between the endoscope (90%) and craniotomy (85%) groups, the median intensive care unit stay was decreased from 11 days to 6 days due to reduced surgical invasiveness. This represents an important advancement in treating spontaneous supratentorial ICH, and provides a measured preview of the promising results that can be expected in the future.
Journal of the Formosan Medical Association = Taiwan yi zhi, 2017
Minimally invasive endoscope-assisted (MIE) evacuation of spontaneous intracerebral hemorrhage (ICH) is simple and effective, but the limited working space may hinder meticulous hemostasis and might lead to rebleeding. Management of intraoperative hemorrhage is therefore a critical issue of this study. This study presents experience in the treatment of patients with various types of ICH by MIE evacuation followed by direct local injection of FloSeal Hemostatic Matrix (Baxter Healthcare Corp, Fremont, CA, USA) for hemostasis. The retrospective nonrandomized clinical and radiology-based analysis enrolled 42 patients treated with MIE evacuation of ICH followed by direct local injection of FloSeal Hemostatic Matrix. Rebleeding, morbidity, and mortality were the primary endpoints. The percentage of hematoma evacuated was calculated from the pre- and postoperative brain computed tomography (CT) scans. Extended Glasgow Outcome Scale (GOSE) was evaluated at 6 months postoperatively. Forty-t...
Endoscopic evacuation of putaminal hemorrhage: how to improve the efficiency of hematoma evacuation
Surgical Neurology, 2005
Background: A unique method of evacuation of hypertensive putaminal hemorrhage (HPH) using a stainless steel tube as a corridor under the assistance of a rigid endoscope is described. A simplified method to determine the precise location for burr hole placement is also reported. Methods: From May 2003 to April 2004, 9 patients with HPH underwent endoscopic surgery in our hospital. Two different entry sites (temporal and frontal) were used to approach the hematoma in our series. Results: The hematoma evacuation rate was more than 90% (median 93%) with the frontal approach and 84% with the temporal approach. Conclusions: Using a combination of a stainless steel tube, rigid endoscope, and coagulation suction with a frontal approach can facilitate optimal evacuation of HPH.
Endoscopic-assisted removal of traumatic brain hemorrhage: case report and technical note
Journal of surgical case reports, 2015
The endoscopic technique has been described as a minimally invasive method for spontaneous hematoma evacuation, as a safe and effective treatment. Nevertheless, to our knowledge, there is no description of a technical report of traumatic intracerebral hematoma removal using the neuroendoscope. A 47-year-old man was admitted sustaining 13 points in Glasgow coma scale with brain computed tomography (CT) scan showing a temporal contusion. Guided by a 3D reconstructed CT, using the program OsiriX®, the posterior limit of the hematoma was identified. A burr hole was placed at the posterior temporal region, and we used the neuroendoscope to assist the hematoma evacuation. The postoperative tomography showed adequate hematoma removal. He was discharged from hospital 48 h after surgery. Two weeks later, he was conscious and oriented temporally. This endoscopic-assisted technique can provide safe removal of traumatic hematomas of the temporal lobe.
Acta Neurochirurgica, 2016
Background Sub-acute/chronic epidural hematoma (EDH) may present with nagging symptoms of headache, nausea, vomiting, lethargy, etc. We attempted to offer a minimally invasive, single burr hole, endoscope-assisted evacuation of EDHs instead of a conventional craniotomy. Methods Seven patients with sub-acute/chronic EDH (six supratentorial and one infratentorial) presented to us 3 to 7 days after low-velocity road traffic accidents with complaints of headache and lethargy. The EDH volumes measured between 20 to 50 ml, and the patients were operated on using a single burr hole made through a small incision. We used 0-, 30-and 70-degree, angulated, rigid, high-definition endoscopes to identify and evacuate the organized clots in the extradural space. Flexible catheters were used for suction and irrigation. After achieving hemostasis, the dura was hitched back to the burr hole site. The wound was closed over a negative suction drain. Results All patients had prompt recovery from symptoms. Postoperative CT scans showed complete or near complete evacuation of the hematomas. The hospital stay and analgesic requirements were minimal. There was no infective complication or conversion to conventional open surgery. The average time for surgery was 77.8 min, and average blood loss was 328.5 ml. Conclusion Endoscope-assisted evacuation of sub-acute/ chronic EDH is a novel concept, which offers quick relief from symptoms in a minimally invasive fashion and a cosmetically acceptable way. None of the standard principles of surgery are hampered. It avoids extensive dissection of the temporalis or sub-occipital muscles. However, achieving hemostasis can be difficult. Further study and better equipment will validate the procedure.
Endoscopic management of spontaneous intracerebral haemorrhage
2020
Background: Endoscopic evacuation of spontaneous intracerebral haemorrhage has gained accepted popularity in the last decades as a minimally invasive technique alternative to traditional craniotomy with increased range of surgical indications to include the ganglionic haematomas that were previously inaccessible. Objectives: to enlighten the endoscopic use for evacuation of intracerebral hemorrhage. Patients & Methods: This study describes a prospective study that was conducted in faculty of medicine Al Azhar University and Damanhour medical national institute from November 2017 to November 2019 to evaluate the use of surgical endoscope in evacuation of spontaneous intracerebral haemorrhage. Results: the study included 28 patients, the intraoperative time was 75 ± 18.65 minutes, the evacuation rate was 90.98% ± 4.6%, and the post-operative Glascow coma scale improved to a mean of 8.50 ± 3.46. Conclusion: The endoscopic evacuation of spontaneous intracerebral hemorrhage is less invas...