A transparent sheath for endoscopic surgery and its application in surgical evacuation of spontaneous intracerebral hematomas

Technical note

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✓ The authors advocate the use of a transparent sheath for guiding an endoscope, a simple and unique tool for endoscopic surgery, and describe preliminary results of its application in the evacuation of hypertensive intracerebral hematomas. This sheath is a 10-cm-long tube made of clear acrylic plastic, which greatly improves visualization of the surgical field through a 2.7-mm nonangled endoscope inserted within. Between April 1997 and December 1998, the authors performed endoscopic evacuation of intracerebral hematomas by using this sheath inserted into the patients' heads through a burr hole. In nine consecutive cases in which the hematoma was larger than 40 ml in volume, nearly complete evacuation (86–100%) of the lesion was achieved without complication. Excellent visualization of the border between the brain parenchyma and the hematoma facilitated accurate intraoperative orientation, and also allowed easy identification of the bleeding point. Thus, this combination of sheath and endoscope achieves both minimal invasiveness and the maximum extent of hematoma removal with secure hemostasis. This tool will reduce the inherent disadvantage of endoscopic procedures and may expand their application in other areas of neurosurgical management.

Article Information

Address reprint requests to: Tetsuhiro Nishihara, M.D., Department of Neurosurgery, The University of Tokyo Hospital, 7–3–1 Hongo, Bunkyo-ku, Tokyo, 113–8655 Japan. email: nishihara-tky@umin.ac.jp

© AANS, except where prohibited by US copyright law.

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Figures

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    Photograph of a transparent sheath and a metal stylet. The sheath is made of acrylic plastic and is attached to a stainless steel handle.

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    Photographs showing surgical procedures. a: The sheath is tightly held by one hand while the suction tip used to evacuate the hematoma is controlled by the other. b: Endoscopic view showing the clear visualization of the brain parenchyma and the border of the hematoma through the transparent sheath. The suction tip (upper left) reaches the middle of the hematoma beyond the tip of the sheath.

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    Axial CT scans demonstrating removal of the hematoma. The estimated volume of the hematoma was 110 ml preoperatively (a), which was efficiently evacuated, leaving only 16 ml of volume on the postoperative CT scan (b).

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