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. 2019 Apr 11:15:919-925.
doi: 10.2147/NDT.S195275. eCollection 2019.

Minimally invasive evacuation of spontaneous supratentorial intracerebral hemorrhage by transcranial neuroendoscopic approach

Qiang Cai  1 , Qiao Guo  1 , Zhiyang Li  1 , Wenju Wang  1 , Wenfei Zhang  1 , Baowei Ji  1 , Zhibiao Chen  1 , Jun Liu  2
Affiliations

Minimally invasive evacuation of spontaneous supratentorial intracerebral hemorrhage by transcranial neuroendoscopic approach

Qiang Cai et al. Neuropsychiatr Dis Treat. .

Abstract

Objective: Spontaneous supratentorial intracerebral hemorrhage (SSICH) is one of the deadliest diseases, and neuroendoscopic surgery (NE) is a minimally invasive and promising treatment that might improve the functional recovery of patients. This study analyzed patient's experience with this treatment in terms of safety, efficacy, and surgical technique.

Patients and methods: Forty-two patients with SSICHs treated by transcranial neuroendoscopic approach were retrospectively reviewed from June 2016 to July 2018 in our department. Patients were classified into four groups according to the main location of the hematoma on CT scans: Group A (basal ganglia hemorrhage), Group B (subcortical hemorrhage), Group C (thalamic hemorrhage), and Group D (intraventricular hemorrhage [IVH]). The clinical data were collected, and the outcomes were analyzed.

Results: All procedures were successfully completed, and no patient died in the perioperative period. The average hematoma evacuation rate was 90.1%, and the highest hematoma evacuation rate was achieved in Group B which was 92.7%. No severe complications occurred, and the average GCS score improvement was 4.0 at discharge.

Conclusion: These data suggest that evacuation hemorrhage by neuroendoscopy might be an effective and safe approach for SSICH. For better efficiency of this treatment, some details needed to be emphasized, such as setting up a good working channel, using of suction and bipolar forceps accurately.

Keywords: minimally invasive surgery; supratentorial intracerebral hemorrhage; transcranial neuroendoscopic approach.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Calculation and analysis of the hematoma volumes and hematoma evacuation rates in the neuroendoscopic surgery patients with the 3D Slice software. Notes: (A) The preoperative hematoma volume was 30.9 mL. (B) The postoperative hematoma volume was 0.3 mL. The hematoma evacuation rate was 99.0%.
Figure 2
Figure 2
Surgical approach for a basal ganglia hemorrhage. Notes: (A) After opening the dura matter, the intracerebral pressure was high. (B) A transparent sheath was inserted into the hematoma cavity, and hematoma was evacuated by neuroendoscopy. (C) A catheter was inserted into the hematoma cavity to drain any residual liquid hematoma after the hematoma was removed. (D) The bone flap was approximately 2.5 cm. (E) The small bone flap was recovered and fixed. (F) The skin incision was short, only approximately 4 cm.
Figure 3
Figure 3
Pre- and post-operation CT scans of a basal ganglia hemorrhage that was evacuated by neuroendoscopy. Notes: (A) Pre-operation CT scan showing the hematoma located in the right basal ganglia. (B) A temporal approach was selected, and a scan performed 1 day after the operation showed that the hematoma was almost completely evacuated. (C) CT scan showing that the hematoma was reduced further 3 days after the operation. (D) CT image showing that no hematoma was present in the brain 2 weeks after the operation. (E) A CT scan collected 1 month later showing that the patient recovered well.
Figure 4
Figure 4
Pre- and post-operation CT scans of a subcortical hemorrhage that was evacuated by neuroendoscopy. Notes: (A) Pre-operation CT scan showing the hematoma located in the right temporal lobe. (B) The corridor that traversed the shortest distance to the hematoma was selected, and a post-operation CT scan showed a near-complete evacuation of the hematoma. (C) CT image showing no hematoma in the brain 3 days after the operation. (D) A CT image of the patient that was collected 2 weeks after the operation. (E) A CT scan that was collected 1 month later showing that the patient recovered very well.
Figure 5
Figure 5
Pre- and post-operation CT scans of a thalamic hemorrhage breaking into the ventricles that was evacuated by neuroendoscopy. Notes: (A) A CT scan collected upon admission showing a small hematoma in the right thalamus. (B) A pre-operation CT scan showing the expansion of the hematoma that broke into the ventricles. (C) CT scan collected 1 day after the operation showing that the hematoma was almost completely evacuated by neuroendoscopy. (D) CT image showing that almost no hematoma was present in the brain 3 days after the operation. (E) MRI image collected 1 month later showing no further damage to the thalamus from the neuroendoscopy and that the patient recovered well.
Figure 6
Figure 6
Pre- and post-operation CT scans of an intraventricular hemorrhage that was evacuated by neuroendoscopy. Notes: (A) Pre-operation CT scan showing that the hematoma was located in the left lateral ventricle. (B) CT scan collected 1 day after the operation showing that the hematoma was almost completely evacuated. (C) CT image showing very little residual hematoma in the brain 3 days after the operation. (D) CT image showing that no hematoma was present in the brain 2 weeks after the operation. (E) CT scan collected 1 month later showing that the patient recovered well.
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