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International Bulletin of Otorhinolaryngology

Early Neuroendoscope-assisted Evacuation of Spontaneous Intracranial Hematomas. Preliminary Report

T. Avramov, Y. Enchev, B. Iliev, D. Handzhiev, T. Kondev

Abstract

Purpose: The surgical techniques, effectiveness and indications of microsurgical neuroendoscopic assisted evacuation of spontaneous intracranial hematomas (SICH) is still uncertain. This minimal invasive technique remains investigational and controversal with regard to patient selection, timing of operation and method of the management. The purpose of this study was to investigate the early postoperative results in patients with SICH underwent endoscopic evacuation and to give evaluation and eventual prognosis of the clinical outcomes after this procedure.
Material and Methods: A retrospective analysis of 56 patients SICH treated in the Neurosurgical clinic with endoscopic assisted evacuation was performed. Hematoma volume and its localization (subcortical – 11 patients, in basal ganglia – 12 – 7 of them with propagation to ventricular system, 6 infratentorial and 27 subdural), comorbidity, clinical features
and timing of surgical procedures was made. The GCS rate by admission and GOS by discharging of patients was analyzed, also the postoperative complications and causes of death.
Results: 52 patients (92, 9%) were operated within the first 24 hours of the onset. Patients operated between the 12 and 24 hours had better outcome in comparison to these operated after the 24 hours period. The authors analyzed their experience with endoscopic technique, effectiveness of the method, results and complications. Mortality rate in our series was 23,
2% (13 patients). The causes of surgical complications and causes of death were analyzed.
Conclusion: The endoscopic assisted evacuation of SICH is a short, safe and very effective method when the surgical procerure is provided within the first 12–24 hours. Our results showed that early and complete evacuation of hematoma volume may promote to recovery of the general condition of the patient and improved outcomes.

Keywords

spontaneous intracranial hematomas – minimally invasive technique – neuroendoscope-assisted evacuation – timing of operation – complications

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References

Adeoye O, Broderick JP: Advances in the management of Intracerebral hemorrhage. Nat Rev Neurol 2010, 6: 593-601.

Adeoye O, Ringer A, Hornung R, Khatri P, Zuccarello M, Kleindorfer D.: Trends in surgical management and mortality of intracerebral hemorrhage in the United States before and after the STICH trial. Neurocrit Care 2010, 13: 82-86.

van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ: Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol 2010, 9(2): 167-176.

Balaji SP, Varma RG, Parthiban JKBC, Krishna KN, Varma RM, Srinivasa R, Acharya PT, Mruthyunjayana BP, Eesha M: Keyhole craniectomy in the surgical management of spontaneous intracerebral hematoma. Neurology Asia 2007, 12: 21 – 27.

Auer LM.: Endoscopic evacuation of intracerebral haemorrhage. High-tech-surgical treatment – a new approach to the problem? Acta Neurochir (Wien) 1985, 74: 124-128.

Blacker DJ, Musuka T : Management of intracerebral hemorrhage in 2020. Future Neurol 2011, 6(6): 745-756.

Broderick JP, Connolly S, Feldman E, Hanley D , Kase C, Krieger D, Mayberg M, Moergenstern L, Odilvy CS, Vespa P, Zuccarello M:Guidelines for the management of spontaneous intracerebral hemorrhage in adults 2007 update. Stroke 2007, 38: 2001-2023.

Chen CC, Cho DY, Chang CS, Chen JT, Lee WY, Lee HC: Astainless steel sheath for endoscopic surgery and its application in surgical evacuation of putaminal haemorrhage. J ClinNeurosci , 2005, 12:937–940.

Chen CC, Lin HL, Cho DY: Endoscopic surgery for thalamic hemorrhage: a technical note. Surg Neurol 2007, 68:438–442.

Cho DY, Chen CC, Chang CS, Lee WY, Tso M: Endoscopic surgery for spontaneous basal ganglia hemorrhage: comparing endoscopic surgery, stereotactic aspiration, and craniotomy in noncomatose patients. Surg Neurol 2006, 65:547–556.

Elliott J, Smith M.: The acute management of intracerebral hemorrhage: a clinical review.Anesth Analg 2010, 110: 1419-1427.

Flower O, Smith M : The acute management of intracerebral hemorrhage. Current Opinion Critical Care 2011, 17: 106-114.

Gang RK: Nontraumatic intracerebal hemorrhage. Medmerits 2011.

Gregson BA, Mendelow AD: International variations in surgical practice for spontaneous intracerebral hemorrhage. AHA/ASA Stroke 2003, 34: 2593-2598.

Hossain M, Ahmed SU, Ansary SAA, et al: Surgical outcome of spontaneous intracerebral haematoma through keyhole craniectomy. Faridpur Med Coll J 2010, 5(2):60-62.

Hsieh PC, Cho DY, Lee WY, Chen JT: Endoscopic evacuationof putaminal hemorrhage: how to improve the efficiency ofhematoma evacuation. Surg Neurol, 2005, 64:147–153.

Kuo LT, Chen CM, Li CH, Tsai JC, Chiu HC, Liu LC, Tu YK, Huang AP : Early endoscope-assisted hematoma evacuation in patients with supratentorial intracerebral hemorrhage: case selection, surgical technique, and long-term results. Neurosurg Focus 2011 30(4): E9.

Liebeskind DS : Intracranial Hemorrhage. Medscape Reference 2011, WebMD 1-10.

Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, et al: Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet 2005, 365:387–397.

Mobbs R, Khong P: Endoscopic-assisted evacuation of subdural collections. J Clin Neurosci 2009, 16: 701-704.

Morgenstern LB, Demchuk AM, Kim DH, et al.: Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage. Neurology 2001, 56: 1294-1299.

Morgenstern LB, Hemphill JC III, Anderson C, et al.: Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart association/American Stroke Association . Stroke 2010, 41: 2108-2129.

Nagasaka T, Inao S, Ikeda H, Tsugeno M, Okamoto T: Inflation-deflation method for endoscopic evacuation of intracerebral haematoma. ActaNeurochir (Wien) 2008, 150:685–690.

Nagasaka T, Tsugeno M, Ikeda H, Okamoto T, Takagawa Y, Inao S, Wakabayashi T: Balanced irrigation-suction technique with a multifunctional suction cannula and its application for intraoperative hemorrhage in endoscopic evacuation of intracerebral hematomas: Technical note. Neurosurgery 2009, 65: 826-827.

Nagasaka T, Tsugeno M, Ikeda H, Okamoto T, Inao S, Wakabayashi T: Early recovery and better evacuation rate in neuroendoscopic surgery for spontaneous intracerebral hemorrhage using a multifunctional cannula:Preliminary study in comparison with craniotomy. J Stroke Cerebrovasc

Dis 2009, 20: 208-213.

Nakano T, Ohkuma H, Ebina K, Suzuki S: Neuroendoscopic surgery for intracerebral haemorrhage—comparison with traditional therapies. Minim Invasive Neurosurg 2003, 46:278–283.

Nishihara T, Nagata K, Tanaka S, Suzuki Y, Izumi M, Mochizuki Y, et al: Newly developed endoscopic instruments for the removal of intracerebral hematoma. Neurocrit Car 2005, 2:67–74.

Nishihara T, Morita A, Teraoka A, Kirino TK.: Endoscopy-guided removal of spontaneous intracerebral hemorrhage: comparison with computer tomography-guided stereotactic evacuation. Childs Nerv Syst 2007, 23: 677-683.

Qureshi AI, Mendelow AD, Hanley DF: Intracerebral hemorrhage. Lancet 2009, 9(373): 1632-1644.

Reichart R , Frank S: Intracerebral hemorrhage, Indication for Surgical Treatment and Surgical Techniques. Open Critical Care Med J , 2011, 4: 68-71.

Sahni R, Weinberger J: Management of intracerebral hemorrhage. Vasc Health Risk Management 2007, 3(5): 701-709.

Steiner T, Boesel J: Options to restrict hematoma expansion after spontaneous intracerebral hemorrhage. Stroke 2010, 41: 402-409.

Sudlow CL, Warlow CP: Comparable studies of the incidence of stroke and its pathological types : results from an international collaboration – International Stroke Incidence Collaboration. Stroke 1997, 28: 491-499.

Sung SK, Kim SH, Son DW, Lee SW: Acute spontaneous subdural hematoma of arterial origin. J Korean Neurosurg Soc 2012, 51: 91-93.

Teernstra OPM, Evers SMAA, Lodder J, Leffers P, Franke CL, Blaauw G: Stereotactic treatment of intracerebral hematoma by means of a plasminogen activator. A multicenter randomized controlled trial (SICHPA). Stroke 2003, 34(4): 968-974.

Thrift AG, Dewey HM, McDonnel RA, McNeil JJ, Donnan GA: Incidence of the major stroke subtypes: initial findings from the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke 2001, 32: 1732-1738.

Wang HS, Kim SW, Kim SH: Spontaneous chronic subdural hematoma in an adolescent girl. J Korean Neurosrg Soc 2013, 53: 201-203.

Wang X, Liang H, Xu M, Shen G, Xu L: Comparison between transsylvian-transinsular and transcortical-transtemporal approach for evacuation of intracerebral hematoma. Acta Chirurg Brazileira 2013, 28(2): 112-118.

Zheng JS, Yang F, Xu QS, Yu JB, Tang LL :Treatment of hypertensive intracerebral hemorrhage through keyhole transsylvian approach. J Craniofac Surg 2010, 21: 1210-1212.

Zhu H, Wang Z, Shi W: Keyhole endoscopic hematoma evacuation in patients. Turk Neurosurg 2012, 22(3): 294-299.

Zucacrello M, Andaluz N, Wagner KR : Minimally invasive therapy for intracerebral hematomas. Neurosurg Clin N Am 2002, 13(3): 349-354.

Zuo Y, Cheng G, Gao DK, Zhang X, Zhen HN, Zhang W, et al:Gross-total hematoma removal of hypertensive basal ganglia hemorrhages: a long-term follow-up. J Neurol Sci 2009, 287:100–104.




DOI: http://dx.doi.org/10.14748/orl.v10i4.6881

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