Newly developed endoscopic instruments for the removal of intracerebral hematoma.
Ultra-early surgical treatment in which associated brain injury is minimized and maximal volume of hematoma is removed shortly after onset with secure hemostasis is expected to be established. We developed a transparent guiding sheath and other surgical instruments for endoscopic surgery and established a novel, ultra-early stage surgical procedure using those instruments. This procedure has the following characteristics: (a) burr hole opening under local anesthesia is possible; (b) a transparent sheath improves the visualization of the surgical field in the parenchyma and the hematoma; (c) free-hand surgery without fixing an endoscope and a sheath to a frame facilitates three-dimensional operation; (d) secure hemostasis by electric coagulation is possible; (e) relatively simple surgical instruments are easy to prepare. We have performed this procedure in 82 patients with intracerebral or intraventricular hemorrhage (44 with putaminal hemorrhage, 12 with thalamic hemorrhage, 8 with subcortical hemorrhage, 8 with cerebellar hemorrhage, 10 with intraventricular hemorrhage). Twenty-four of those patients received our treatment in the ultra-early stage (within 3 hours after onset). The mean duration of surgery was 63 minutes, the mean hematoma reduction rate was 96%, and no peri-operative hemorrhage with deterioration of symptoms and/or signs occurred. Therefore, we believe that endoscopic hematoma evacuation with our surgical procedure is a promising ultra-early stage treatment for intracerebral hemorrhage and that it may improve the long-term prognosis in patents with intracerebral hemorrhage.
Nishihara
Tetsuhiro
T
Department of Neurosurgery, Kanto Medical Center NTT EC, Tokyo, Japan. nishihara-tky@umin.ac.jp
Nagata
Kazuya
K
Tanaka
Shota
S
Suzuki
Yasutaka
Y
Izumi
Masafumi
M
Mochizuki
Yubuhito
Y
Akabane
Atsuya
A
Ochiai
Chikayuki
C
D004867:Equipment Design; D006406:Hematoma / Q000209:etiology / Q000601:surgery*; D006801:Humans; D020299:Intracranial Hemorrhage, Hypertensive / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D013525:Surgical Instruments