Evacuation of intracerebral hemorrhages by neuroendoscopy with transparent sheath. Experimental study (original) (raw)
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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...
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 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.
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.
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.
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...
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...
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...
Endoscopic surgery for thalamic hemorrhage: a technical note
Surgical Neurology, 2007
Background: Approximately 10% to 15% of cases of ICH involve the thalamus. Evacuation of a thalamic hematoma by craniotomy is associated with high rates of mortality and morbidity. Evacuation by endoscopic surgery is less invasive but is relatively inefficient because of limited visualization of the surgical field. Therefore, a procedure using a polypropylene endoscopic sheath was developed to improve endoscopic visualization and the efficiency of endoscopic evacuation of thalamic hematoma. Methods: From September 2004 to September 2005, 7 patients underwent endoscopic evacuation of posterial-lateral type thalamic hemorrhage that had ruptured into the lateral ventricle of the trigum and caused acute hydrocephalus. The clinical evaluation included pre-and postoperative Glasgow Coma Scale (GCS) score, 30-day mortality rate, and Glasgow Outcome Scale score 6 months later. The surgical procedure was performed with the patient in the supine position while under general anesthesia. A 3-cm incision was made across the occipital-parietal scalp ipsilateral to the thalamic hematoma. A burr hole, 1 cm in diameter, was drilled on the Keen's point, which is located 3 cm posterior and 3 cm superior to the pinna. A transcortical intraventricular puncture was made with a rigid endoscopic tube. A 2.7-mm endoscope and the necessary surgical instruments were then inserted through this tube, permitting the simultaneous removal of hematoma in the intraventricular space and thalamus. A surgical demonstration of this technique to evacuate thalamic hemorrhage in a patient with acute hydrocephalus is provided herein. Results: The preoperative mean GCS score was 8.4 and the postoperative mean GCS score was 9.4. The 30-day mortality rate was 15% and none of the patients developed shunt-dependent hydrocephalus. The average Glasgow Outcome Scale score was 3.7 six months later. Conclusion: Use of a rigid endoscopic sheath in combination with an endoscope and an approach from Keen's point to the collateral trigone of the lateral ventricle improves the efficiency of evacuating thalamic hematomas and prevents shunt-dependent hydrocephalus.
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.