Advantages of disposable portable endoscope in removing thalamic hematoma via the superior parietal lobule

Abstract

Objectives: Thalamic hematoma patients present with diverse clinical conditions, and treatment approaches vary widely. Currently, the use of disposable portable endoscope surgery has been rapidly adopted in many hospitals, but outcomes can vary significantly. Surgical approaches and techniques for thalamic hematoma often reference those used for basal ganglia hemorrhage, but their effectiveness remains uncertain. This study aims to explore the advantages of using disposable portable endoscopes in removing thalamic hematoma via the superior parietal lobule, providing guidelines for clinicians to manage thalamic bleeding effectively.

Methods: Clinical data of patients with thalamic hematoma who underwent either disposable portable endoscope or microscope surgery at the Third Xiangya Hospital, Central South University, were retrospectively analyzed. Surgical duration, hematoma clearance rate, length of hospital stay, improvement rate in Glasgow Coma Scale (GCS) score at 24 hours post-operation, and incidence of pulmonary infection were compared between the 2 groups.

Results: Compared with the microscope group, the disposable portable endoscope group had shorter operation time, higher hematoma clearance rate, shorter hospital stay, and lower incidence of pulmonary infection (all P<0.05). However, there was no significant difference in the improvement rate of GCS score at 24 hours post-operation between the 2 groups (P>0.05).

Conclusions: In the surgical removal of thalamic hematoma via the superior parietal lobule, the disposable portable endoscope offers advantages such as shorter surgical duration, better visualization, higher hematoma clearance rate, improved surgical efficiency, shorter hospital stay, and lower incidence of pulmonary infection. Therefore, it can be considered as a preferred surgical treatment option for patients with thalamic hematoma.

Keywords: basal ganglia hemorrhage; disposable portable endoscope; endoscopic surgery; microscopic surgery; superior parietal lobule approach; thalamic hemorrhage.

图1

一次性便携式内镜系统的组成 Figure 1 Composition of disposable portable endoscopic system A: Composition of disposable portable endoscopic system, including the portable endoscope (①), the outer sheath of the endoscope (②), the working channel tube core (③), and the working channel (④). B: Image is connected to the computer via USB (⑤).

图2

使用一次性便携式内镜经顶上小叶清除丘脑血肿的手术过程 Figure 2 Surgical procedures of removing the thalamic hematoma through the superior parietal lobule via using disposable portable endoscope A: Surgical incision. B: Portable endoscope and the outer sheath of the endoscope form a contact endoscope, which can puncture the brain tissue under direct vision. The screen shows: White matter (①); enter the ventricle with blood (②); enter the hematoma (③). After arriving at the hematoma, push the working channel and the working channel tube core into the hematoma to establish the working channel. C: Tube core of the working channel and the outer sheath of the endoscope are extracted, and the working channel is indurated in the brain. D: Portable endoscope and aspirator are used to remove the hematoma under direct vision. E: Postoperative indwelling drainage tube.

图3

经顶上小叶手术的内镜视野和显微镜视野对比 Figure 3 Comparison of endoscopic and microscopic fields of view during surgery A: Surgical direction; B: Microscopic surgical field of view; C: Endoscopic surgical field of view.

图4

一次性便携式内镜组手术前和手术后24 h的CT对比 Figure 4 CT comparison of the disposable portable endoscope group before and 24 hours after surgery A: Preoperative CT shows thalamic hematoma and intraventricular hematoma. B: Postoperative CT at 24 hours shows complete clearance of thalamic hematoma and intraventricular hematoma.

图5

显微镜组手术前和手术后24 h的CT对比 Figure 5 CT comparison of the microscope group before and 24 hours after surgery A: Preoperative CT shows thalamic hematoma and intraventricular hematoma. B: Postoperative CT at 24 hours shows that the thalamic hematoma is completely cleared, but the hematoma in the ventricular body and frontal horn is not forcibly cleared.