被殻出血に対する内視鏡下血腫除去術─手術手技の工夫─

抄録

Endoscopic surgery has become recognized as a less invasive and safe surgery for putaminal hemorrhage. However, the operative technique has remained controversial. The approach for endoscopic surgery for putaminal hemorrhage in our institution was examined.
We started performing endoscopic surgery for putaminal hemorrhage in January 2006, and examined 92 patients treated with this approach. A rigid endoscope and irrigation suction were used, with a “Freehand Technique”, as previously described. The mean age of patients was 61.1 ± 11.3 years, and the mean hematoma volume was 65.4 ± 27.6 mL. Local anesthesia was used for endoscopic surgery in 66.3% (61/92) of patients. The mean operation time was 89.8 ± 30.2 min, and the mean hematoma removal rate was 94.2 ± 9.7%. The re-bleeding rate was 4.3%, and the rate of mortality caused by rebleeding was 2.2% (2/92).
Based on this experience, a few points related to endoscopic hematoma evacuation of putaminal hemorrhage were identified. The first point is the use of a clear sheet, allowing visualization of operative markers such as the nasion and external auditory canal. The second point is the method of connection for the irrigation suction, which allows the operator to independently perform coagulation of bleeding points. Using a “Freehand Technique”, it is not necessary to use other precision instruments, and it is easy and safe to insert a sheath into the hematoma. We consider that this technique may be a less invasive, simple, and effective method for treating putaminal hemorrhage.