Effective Combined Use of Rigid and Flexible Endoscopes for Evacuation of Casting Intraventricular Hematoma

Abstract

Summary: Neuroendoscopic surgery may be more advantageous for patients with a massive intraventricular ematoma (IVH) compared to conventional procedures such as external ventricular drainage erformed alone. We proposed the effectiveness of a combination of flexible and rigid endoscopes hen compared with the use of a single flexible endoscope in hematoma evacuation surgeries for IVH. e studied 26 consecutive patients who had IVH associated with intracerebral hemorrhage between pril 2011 and October 2017. The first 16 patients with IVH were treated using a single flexible endoscope the flexible group). The remaining 10 patients with IVH were treated with a combination of lexible and rigid endoscopes (the combined group). The average postoperative hematoma evacuation atio was higher in the combined group than in the flexible group (combined: 58 ± 9.3% vs. flexible: 6 ± 6.5%). No differences were observed in the duration of intraventricular drainage, additional cerebrospinal luid shunt surgeries, or outcome on discharge between the groups. A rigid endoscope is ffective for rapid removal of a hard hematoma. However, its use in the dry field narrows the operative avity, leading to deterioration of the visibility of the bleeding point. In contrast, the diving technique sing a flexible endoscope in the wet field enables amelioration of the visibility of the bleeding oint or that of the anatomical structures by enlarging the objective cavities. Thus, it enables the removal f deep-seated hematoma in the third ventricle or in the aqueduct. However, hard and large hematomas re sometimes difficult to remove due to their small working channel.

The combined use of a flexible and a rigid endoscope enabled effective and safe hematoma evacuation n patients with casting IVH. It was the most important point to optimize the order and timing of witching, accounting for the respective advantages and disadvantages.