抄録
Endoscopic surgery plays a significant role in the treatment of intracerebral hemorrhage. However, the amount of residual hematoma cannot be measured intraoperatively from the endoscopic view, and it is difficult to know the precise location of the endoscope within the hematoma cavity. Therefore, we attempted to develop real-time ultrasound-guided endoscopic surgery using a burr hole type probe.
From May 2011 to February 2013, 12 patients with hypertensive intracerebral hemorrhage underwent endoscopic removal of hematomas. Six patients had putaminal hemorrhage, and six patients had thalamic hemorrhage with intraventricular perforation. Real-time ultrasound-guidance was performed with a burr hole type probe, through a burr hole made in the temporal region, to observe the endoscopic operation from another burr hole in the frontal region. Endoscopic sheath insertion was also guided. During removal of the hematoma, the operator navigated adequately based upon the information of the location of the residual hematoma. Finally, the remaining cavity was irrigated by artificial cerebrospinal fluid and was observed as a low echoic space, which enabled obvious detection of the hematoma.
This method allowed both real-time navigation of the endoscope and real-time viewing of the residual hematoma, which thus minimized the brain damage due to the surgery. While the second burr hole for real-time guidance increased the number of wounds during surgery, it might decrease brain injury.
