Usefulness of a new neuroendoscope brain cylinder for intracerebral hematoma surgery

Abstract

Objective: In multiple series, intracerebral hematomas have been removed via endoscopic surgery. Although endoscopic surgery with tubular retractors has been able to access deep-seated lesions, it is difficult to confirm the depth of the retractor sheath in the surgical field using only the outer sheath. We built various sizes and lengths of neuroendoscopic cylinders, developed by the Japan Science and Technology Agency (JST) revitalization promotion program, with numerical scales visible during both endoscopic and radiographic procedures. Method and results: The JST developed cylinders using new techniques for tantalum film implantation to form tubes made of fluorinated ethylene propylene. We successfully and safely removed various hematomas using these cylinders because we were able to clearly visualize the border of the brain parenchyma and the depth from the brain surface in the cylinder. In addition, we confirmed the area from the posterior to anterior horn using a 14-cm long cylinder during a trans-posterior horn approach under continuous irrigation for thalamic hemorrhage with ventricular hematoma. We ensured coagulation at the bleeding point with a bipolar coagulator using a brain cylinder, 12-mm in diameter, in a patient on antiplatelet therapy. Conclusion: Cylinders equipped with a visible scale for both endoscopic and radiographic procedures, developed by JST programs, potentially provide greater patient safety during endoscopic surgery, negating, in some cases, the need for various inspections during surgery. In future, various sizes and lengths of cylinders might be useful across a variety of cases under endoscopic and radiographic guidance. Keywords: Brain cylinder, Endoscopically and radiographically visible scale, Neuroendoscopic surgery of intracerebral hematoma