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International Bulletin of Otorhinolaryngology

Early surgical treatment of thalamic intracerebral hematomas with penetration into the Ventricular System – clinical experience

B. Iliev, Y. Enchev, T. Avramov, Pl. Trendafilov, D. Handjiev, T. Kondev

Abstract

Introduction: Surgical treatment of ICH is still subject of controversy regarding the indications, timing and methodology The object of this study is a series of cases with thalamic ICH with penetration into the Ventricular System undergoing surgery.
Materials and Methods: In patients with thalamic ICH with penetration into the Ventricular System, the goal is to relieve acute hydrocephalus and increased ICP, along with the maximum possible removal of intraventricular hematoma (IVH), with minimal damage to the brain parenchyma. Surgery
involves attaching an extraventricular drainage with or without evacuation of ICH / IVH, with or without neuroendoscopically control.
Result: The series includes 15 patients with thalamic intracerebral haematomas. In 2 cases of partial evacuation of ICH, IVH and attaching an extraventricular drainage. In 5cases partial evacuation of IVH and attaching an external ventricle drainage. In 8 cases placed only external ventricle drainage. Mortality in the postoperative period was 80% (12 cases). Bleeding recurrence was seen in 30%. Improvement of neurological
status in the early postoperative period was reported in 60% (9 cases). Tracheotomy were performed in 40% (6 cases). The average score GOSE is 1 to 3-month follow-up.
Conclusion: The achieved results in this series are not satisfying. However, some patients with such haematomas may benefit from this treatment. Thus, further studies with higher number of cases are required
ASA = American Stroke Association; EVD = extraventricular drain; GOSE = extended Glasgow Outcome Scale; ICH = intracerebral hemorrhage (интрацеребрална хеморагия); ICP = intracranial pressure; IVH = intraventricular hemorrhage; CT = computed tomography

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References

Suyama D, Ito K, Tanii M, Furuichi S, Yoshizawa T, Yamagiwa O: Neuroendoscopic surgery for intracerebral hematomas using a transparent sheath—technique and results of putaminal, thalamic, and lobar hemorrhages. Int Congr Ser 1259:279–286, 2004

Bakshi A, Bakshi A, Banerji AK: Neuroendoscope-assisted evacuation of large intracerebral hematomas: Introduction of a new, minimally invasive technique.Preliminary report. Neurosurg Focus 16:e9, 2004.

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

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

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 30 (4):E9, 2011

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

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 Care 2: 67–74, 2005

Lewis B. Morgenstern, MD, FAHA, FAAN, Chair; J. Claude Hemphill III, MD, MAS, FAAN, Vice-Chair; Craig Anderson, MBBS, PhD, FRACP; Kyra Becker, MD; Joseph P. Broderick, MD, FAHA; E. Sander Connolly, Jr, MD, FAHA; Steven M. Greenberg, MD, PhD, FAHA, FAAN; James N. Huang, MD; R. Loch Macdonald, MD, PhD; Steven R. Messй, MD, FAHA; Pamela H. Mitchell, RN, PhD, FAHA, FAAN; Magdy Selim, MD, PhD, FAHA; Rafael J. Tamargo, MD; on behalf of the American Heart Association Stroke Council and Council




DOI: http://dx.doi.org/10.14748/orl.v10i3.6894

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