脳卒中の外科
Online ISSN : 1880-4683
Print ISSN : 0914-5508
ISSN-L : 0914-5508
総  説
内視鏡下血腫除去術の基本と応用
山本 拓史川村 海渡杉山 夏来鈴木 一幹上野 英明渡邉 瑞也中尾 保秋
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2020 年 48 巻 3 号 p. 190-195

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Endoscopic hematoma evacuation is a key minimally invasive procedure learned by young neurosurgeons. It can help them to improve their surgical technique and understand the differences between techniques, including microscopic surgery. The surgical indication for endoscopic hematoma evacuation should be performed in compliance with the guidelines for stroke management.

The hematoma clots can be removed using a rigid endoscope and a suction tube in a transparent sheath. The surgical procedure is performed in four steps. First, the position of the burr hole should be determined. Second, a transparent sheath should be inserted into the hematoma cavity. This has to be done very carefully because a wrong trajectory may cause severe morbidity. The sheath tip should be guided to the boundary between the brain parenchyma and the hematoma. Third, hematoma aspiration should commence under an endoscopic view. Finally, a suction tube should be used as a probe adapted to the monopolar coagulator system for hemostasis. Continuous irrigation using artificial cerebrospinal fluid can also be useful for confirming the bleeding point.

Endoscopic hematoma evacuation may be advantageous than microscopic surgery for cerebellar hemorrhage and intraventricular hematoma (IVH). In patients with IVH, the hematoma can be removed from the bilateral lateral ventricle and third ventricle via a one-side anterior puncture. In patients with spontaneous cerebellar hemorrhage, it is possible to remove an intraparenchymal hematoma and a hematoma in the fourth ventricle through a single burr hole. Furthermore, the operation time and the hematoma removal ratio are significantly improved.

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