title: Balanced irrigation-suction technique with a multifunctional suction cannula and its application for intraoperative hemorrhage in endoscopic evacuation of intracerebral hematomas: technical note.
abstract: OBJECTIVE
  Endoscopic evacuation of intraoperative hemorrhage is proving to be increasingly useful and effective. For general agreement that endoscopic evacuation has advantages over craniotomy, secure hemostatic procedures are crucial.
  
  
  METHODS
  This technical note focuses on hemostatic procedures for managing intraoperative hemorrhage. Handling of the multifunctional suction cannula and its application for balanced irrigation-suction are fully explained in this report.
  
  
  RESULTS
  Nearly complete evacuation of hematoma was achieved in all 15 cases. In 9 cases of intraoperative arterial bleeding, secure hemostatis has been accomplished. No surgical complications or rebleeding occurred.
  
  
  CONCLUSIONS
  Even careful atraumatic evacuation of a hematoma can sometimes result in intraoperative hemorrhage. Repeated irrigation and point suctioning may be necessary to keep the operating field clear. A multifunctional suction cannula would be useful for maintaining irrigation and suction balance. Coagulation of a bleeding artery can be performed under clear visualization. A balanced irrigation-suction technique results in secure hemostasis.
authors.affiliation: Department of Neurosurgery, Japanese Red Cross, Nagoya Daiichi Hospital, Nagoya, Aichi, Japan. toru-ngy@umin.ac.jp
authors.forename: Toru
authors.initials: T
authors.lastname: Nagasaka
authors.forename: Masanori
authors.initials: M
authors.lastname: Tsugeno
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ikeda
authors.forename: Takeshi
authors.initials: T
authors.lastname: Okamoto
authors.forename: Yuya
authors.initials: Y
authors.lastname: Takagawa
authors.forename: Suguru
authors.initials: S
authors.lastname: Inao
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Wakabayashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D016558:Hemostasis, Endoscopic / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D007431:Intraoperative Complications / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery; D013396:Suction / Q000295:instrumentation / Q000379:methods; D007507:Therapeutic Irrigation / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods*