Endoscopic evacuation of intracerebral haemorrhage. High-tec-surgical treatment--a new approach to the problem?

Abstract

A new combination of technologies has been used for the evacuation of intracerebral haemorrhages: The aim is 1. minimal trauma to cerebral tissue in the surgical approach, 2. atraumatic rather than complete removal of blood clots, 3. better prevention of rebleeding. Via a 1 cm burrhole, a 6 mm luminal diameter endoscope is introduced and connected to a video display. Using a suction-irrigation system in the endoscope, fluid turbulence and rhythmic pressure variation in the haematoma cavity at 10-15 mm Hg allow the evacuation of the haematoma under visual control. Bleeding vessels can be coagulated using a 1.5 mm luminal diameter Neodym YAG Laser Microtube. If a small craniotomy is performed instead of only a burrhole, facilities for intraoperative ultrasonic display of the haematoma provide additional control thereby enhancing precision and protection of cerebral tissue on approaching the haematoma and during its evacuation.