Endoscopic management of spontaneous intracerebral haemorrhage (original) (raw)
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Endoscopic Management of Intracerebral Hemorrhage
World Neurosurgery, 2013
Massive intraventricular hemorrhage is a life-threatening condition that requires aggressive management to decrease intracranial hypertension. Intraventricular blood is a strong prognostic predictor of outcome. We describe the technical details and clinical management of the neuroendoscopic aspiration of intraventricular blood in our 12 years' experience, highlighting pitfalls and advantages of the technique.
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.
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...
Image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage
Surgical Neurology, 2008
Background: Spontaneous ICH is a devastating disease with high morbidity and mortality. Intracerebral hemorrhage lacks an effective medical or surgical treatment despite the acknowledged pathophysiologic benefits of achieved hemostasis and clot removal. Image-guided stereotactic endoscopic hematoma evacuation is a promising minimally invasive approach designed to limit operative injury and maximize hematoma removal. Methods: A single-center randomized controlled trial was designed to assess the safety and efficacy of stereotactic hematoma evacuation compared to best medical management. Patients were randomized within 24 hours of hemorrhage in a 3:2 fashion to best medical management plus endoscopic hematoma evacuation or best medical management alone. Data were collected to assess efficacy and safety of hematoma evacuation and to identify procedural components requiring technical improvement. Results: Ten patients have been enrolled and randomized to treatment. Six patients underwent endoscopic evacuation with a hematoma volume reduction of 80% ± 13% at 24 hours post procedure. The medical arm demonstrated a hematoma enlargement of 78% ± 142% during this same period. Rehemorrhage rates and deterioration rates were similar in the 2 groups. Mortality was 20% in the endoscopic group and 50% in the medical treatment cohort. The endoscopic technique was shown to be effective in identification and evacuation of hematomas, whereas reduction in the number of endoscopic passes and maintenance of hemostasis require further study. Conclusion: Image-guided stereotactic endoscopic hematoma removal is a promising minimally invasive technique that is effective in immediate hematoma evacuation. This technique deserves further investigation to determine its role in ICH management.
East and Central African Journal of Surgery, 2018
Background: Minimally invasive surgery (MINS) is being viewed as the more practical alternative to the traditional craniotomy for the evacuation of spontaneous intracerebral haemorrhage (sICH). Most such sICH arises as complications of systemic hypertension. The techniques of MINS described are not currently affordable in most developing countries. Methods: An annotated technique of mini-craniotomy under local anaesthesia (LA) is here described as a stop-gap solution to this problem. An outcome study of this surgical technique in a prospective consecutive patient population is also presented. Results: Twenty-one patients, 13 males, mean age 41.1 years, underwent this surgical procedure. Clinical presentation of the sICH was generally severe: 48% in coma, 81% critically ill, and many of these cases were complicated with high fever, meningism, and chest morbidity. The Glasgow Coma Scale score was 3/15 to 8/15 and 9/15 to 12/15, respectively, in 9 of 21 cases (42.9%) each. The ICH show...
Scientific Reports
The surgical efficacy for supratentorial intracerebral hemorrhage (ICH) remains unknown. We compared the advantages of the widely practiced endoscopic hematoma removal under local anesthesia with that of craniotomy under general anesthesia for ICH. We also focused on our novel operative concept of intentional hematoma leaving technique to avoid further damage to the brain. We retrospectively analyzed 134 consecutive patients (66 endoscopies and 68 craniotomies) who were surgically treated for supratentorial ICH. The characteristics of the 134 patients were as follows: The median (interquartile range) age was 73 (61–82) years. The median Glasgow Coma Scale scores at admission, on day 7, and the median modified Rankin Scale (mRS) score at 6 months were 10 (7–13), 13 (10–14), and 4 (3–5) respectively. The statistical comparison revealed there were no differences in GCS score on day seven between the endoscopy 13 (12–14) and craniotomy group 12 (9–14). No differences were observed in mR...
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...
2015
Objectives: Endoscopic evacuation of intracerebral hemorrhage (ICH) has been developed in order to reduce the tissue injury that conventional craniotomy could generate. Experimental studies are important to assess the effectiveness of the technique and its modifications. The objectives of this study are to develop in pig an experimental model of endoscopic evacuation of ICHs, to assess effectiveness of surgical evacuation, and to evaluate a new transparent sheath as complement to the endoscopy. Methods: Autologous blood was infused into the frontal lobe white matter in 16 pigs. In the problem group, endoscopic evacuation was performed with the aid of a new transparent sheath, which has outer and inner sheaths with blunt and closed finals. Pigs were sacrificed at 4 h, 24 h and 5 days. The volumes of hematoma and histopathological features were determined. Results: Residual volume of the problem group was significantly 70.09% lower than in control group, without significant difference...
Neurosurgical Focus, 2013
Surgical evacuation of nontraumatic, supratentorial intracerebral hemorrhage (SICH) is uncommonly performed, and outcomes are generally poor. On the basis of published experimental data and the authors' anecdotal observations, a retrospective chart review study was performed to test the hypothesis that large decompressive craniectomies (DCs), compared with craniotomies, would improve clinical outcomes after surgical evacuation of SICH. For patients with putaminal SICH, DC was associated with a statistically significant improvement in midline shift, compared with craniotomy. Decompressive craniectomies also resulted in a strong trend toward decreased likelihood of poor neurological outcome (modified Rankin Scale score > 3). For patients with lobar SICH, no associations were found between DC or craniotomy and clinical outcomes. For patients selected to undergo surgical evacuation of putaminal SICH, a DC in addition to surgical evacuation of the hematoma might improve outcome.
Minimally invasive surgery for intracerebral haemorrhage
Current opinion in critical care, 2014
Spontaneous intracerebral haemorrhage (ICH) imposes a significant health and economic burden on society. Despite this, ICH remains the only stroke subtype without a definitive treatment. Without a clearly identified and effective treatment for spontaneous ICH, clinical practice varies greatly from aggressive surgery to supportive care alone. This review will discuss the current modalities of treatments for ICH including preliminary experience and investigative efforts to advance the care of these patients. Open surgery (craniotomy), prothrombotic agents and other therapeutic interventions have failed to significantly improve the outcome of these stroke victims. Recently, the Surgical Trial in Intracerebral Haemorrhage (STICH) II assessed the surgical management of patients with superficial intraparenchymal haematomas with negative results. MISTIE II and other trials of minimally invasive surgery (MIS) have shown promise for improving patient outcomes and a phase III trial started in...