Neuroendoscope-assisted evacuation of large intracerebral hematomas: introduction of a new, minimally invasive technique

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Object

The aim of this study was to describe a new, minimally invasive technique for the endoscopic evacuation of intracerebral hematomas (ICHs) and the clinical and radiological outcomes in patients who underwent the procedure. The authors used a multifunctional three-in-one endoscopic instrument that combines a 0°, 4-mm rigid telescope, an irrigation cannula, and a cautery electrode.

Methods

In 13 patients a small keyhole craniotomy was made through noneloquent cortex to gain access to the hematoma. After opening the dura mater, a small cortical tunnel (~6 mm in diameter) was created using bipolar forceps and suction to enter into the clot. The three-in-one endoscope was then introduced to provide illumination and irrigation inside the cavity. The clot was safely aspirated under endoscopic vision and constant irrigation by performing microsurgical suction with the other hand. Hemostasis could be achieved using electrocautery and Surgicel. This technique eliminates the use of an endoscopic sheath, thus providing more maneuverability to the neurosurgeon. The brilliant illumination provided by the endoscope and the possibility of using electrocautery in the depths of the brain combined with the increased maneuverability make this technique valuable. Near-complete hematoma evacuation was achieved in 11 (85%) of 13 patients. There were four deaths (30%).

Conclusions

Safe and effective evacuation of large ICHs is possible by using the three-in-one endoscopic device. Appropriate indications for surgery in patients with large intracerebral hemorrhage must be developed.

Abbreviations used in this paper:CT = computerized tomography; ICH = intracerebral hematoma; ICU = intensive care unit.

Object

The aim of this study was to describe a new, minimally invasive technique for the endoscopic evacuation of intracerebral hematomas (ICHs) and the clinical and radiological outcomes in patients who underwent the procedure. The authors used a multifunctional three-in-one endoscopic instrument that combines a 0°, 4-mm rigid telescope, an irrigation cannula, and a cautery electrode.

Methods

In 13 patients a small keyhole craniotomy was made through noneloquent cortex to gain access to the hematoma. After opening the dura mater, a small cortical tunnel (~6 mm in diameter) was created using bipolar forceps and suction to enter into the clot. The three-in-one endoscope was then introduced to provide illumination and irrigation inside the cavity. The clot was safely aspirated under endoscopic vision and constant irrigation by performing microsurgical suction with the other hand. Hemostasis could be achieved using electrocautery and Surgicel. This technique eliminates the use of an endoscopic sheath, thus providing more maneuverability to the neurosurgeon. The brilliant illumination provided by the endoscope and the possibility of using electrocautery in the depths of the brain combined with the increased maneuverability make this technique valuable. Near-complete hematoma evacuation was achieved in 11 (85%) of 13 patients. There were four deaths (30%).

Conclusions

Safe and effective evacuation of large ICHs is possible by using the three-in-one endoscopic device. Appropriate indications for surgery in patients with large intracerebral hemorrhage must be developed.

Abbreviations used in this paper:CT = computerized tomography; ICH = intracerebral hematoma; ICU = intensive care unit.

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Article Information

Contributor Notes

Address reprint requests to: Ajay Bakshi, M.Ch., Department of Neurosurgery, Neurobiology, and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Room 272, Philadelphia, Pennsylvania 19129. email: ab99@drexel.edu.

© AANS, except where prohibited by US copyright law.

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