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

Abstract

Qiang Cai,1 Qiao Guo,1 Zhiyang Li,1 Wenju Wang,1 Wenfei Zhang,1 Baowei Ji,1 Zhibiao Chen,1 Jun Liu2 1Department of Neurosurgery, Renmin Hospital of Wuhan University, Hubei Province, People’s Republic of China; 2Department of Emergency, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China 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: supratentorial intracerebral hemorrhage, transcranial neuroendoscopic approach, minimally invasive surgery

Keywords

• Spontaneous supratentorial intracerebral hemorrhage
• Transcranial neuroendoscopic approach
• Minimally invasive surgery