Endoscopic Evacuation of Basal Ganglia Hematoma: Surgical Technique, Outcome, and Learning Curve.
BACKGROUND
Minimally invasive endoscopic hematoma evacuation is a promising treatment option for intracerebral hemorrhage. However, the technique still needs improvement. We report our clinical experience of using this technique to evacuate deep-seated basal ganglia hematomas.


METHODS
The frontal approach was used in most patients. The preoperative and postoperative hematoma volumes, Glasgow Coma Scale, hematoma evacuation rate, 30-day mortality, and long-term outcome defined by the modified Rankin Scale were analyzed retrospectively. The surgical duration per milliliter of clot (DPM) was calculated. The learning curve for this technique was determined based on the relation between the DPM and evacuation rate per the number of cases experienced.


RESULTS
A total of 24 patients were enrolled. The evacuation rate was 87% ± 10%. The average Glasgow Coma Scale score recovered from 8 to 13 after surgery. Twenty-one patients had follow-up data. The follow-up time was 13 ± 6 months. The 30-day mortality after surgery was zero. Forty-eight percent of patients (10/21) achieved a favorable outcome. The DPM (P = 0.92) and evacuation rate (P = 0.64) did not change substantially with the number of cases experienced.


CONCLUSIONS
Endoscopic port surgery for hematoma evacuation via the frontal approach is a safe surgical option for deep-seated basal ganglia hematomas. This technique is minimally invasive and may be helpful to provide better long-term outcomes for selected patients. For neurosurgeons, the learning curve for this technique is steep, which implies that the skills needed for our technique can be easily acquired.
Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China; Department of Geriatric Endocrinology, Chinese PLA General Hospital, Beijing, China.
Lichao
L
Ma
Department of Neurosurgery, Chinese PLA General Hospital Hainan Branch, Sanya, China.
Yuanzheng
Y
Hou
Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China.
Ruyuan
R
Zhu
Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China. Electronic address: chxlei@mail.sysu.edu.cn.
Xiaolei
X
Chen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001479:Basal Ganglia / Q000000981:diagnostic imaging / Q000601:surgery*; D000072226:Computed Tomography Angiography; D005260:Female; D015600:Glasgow Coma Scale; D006406:Hematoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D059032:Learning Curve; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
Basal ganglia hematoma; Endoscope; Surgery