title: Real-time ultrasound-guided endoscopic surgery for putaminal hemorrhage.
abstract: OBJECTIVE
  Endoscopic surgery plays a significant role in the treatment of intracerebral hemorrhage. However, the residual hematoma cannot be measured intraoperatively from the endoscopic view, and it is difficult to determine the precise location of the endoscope within the hematoma cavity. The authors attempted to develop real-time ultrasound-guided endoscopic surgery using a bur-hole-type probe.
  
  
  METHODS
  From November 2012 to March 2014, patients with hypertensive putaminal hemorrhage who underwent endoscopic hematoma removal were enrolled in this study. Real-time ultrasound guidance was performed with a bur-hole-type probe that was advanced via a second bur hole, which was placed in the temporal region. Ultrasound was used to guide insertion of the endoscope sheath as well as to provide information regarding the location of the hematoma during surgical evacuation. Finally, the cavity was irrigated with artificial cerebrospinal fluid and was observed as a low-echoic space, which facilitated detection of residual hematoma.
  
  
  RESULTS
  Ten patients with putaminal hemorrhage>30 cm3 were included in this study. Their mean age (±SD) was 60.9±8.6 years, and the mean preoperative hematoma volume was 65.2±37.1 cm3. The mean percentage of hematoma that was evacuated was 96%±3%. None of the patients exhibited rebleeding after surgery.
  
  
  CONCLUSIONS
  This navigation method was effective in demonstrating both the real-time location of the endoscope and real-time viewing of the residual hematoma. Use of ultrasound guidance minimized the occurrence of brain injury due to hematoma evacuation.
authors.affiliation: Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Sadahiro
authors.affiliation: Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Sadahiro
authors.initials: S
authors.lastname: Nomura
authors.affiliation: Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Hisaharu
authors.initials: H
authors.lastname: Goto
authors.affiliation: Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Sugimoto
authors.affiliation: Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Inamura
authors.affiliation: Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Fujiyama
authors.affiliation: Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Yamane
authors.affiliation: Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Oku
authors.affiliation: Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Mizuya
authors.initials: M
authors.lastname: Shinoyama
authors.affiliation: Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Michiyasu
authors.initials: M
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D000368:Aged; D003199:Computer Systems; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D020299:Intracranial Hemorrhage, Hypertensive / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011446:Prospective Studies; D020146:Putaminal Hemorrhage / Q000473:pathology / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013702:Temporal Lobe / Q000000981:diagnostic imaging / Q000601:surgery; D007507:Therapeutic Irrigation; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; ICH = intracerebral hemorrhage; bur hole; endoscopic surgery; intracerebral hemorrhage; real-time; surgical technique; ultrasound; vascular disorders