2000 Volume 28 Issue 6 Pages 458-464
Neuroendoscopic evacuation of intracerebral hematoma has been mostly performed using a rigid endoscope system with stereotactic guidance. A major disadvantage of this method is that intraoperative evaluation of the residual hematoma is difficult, and that fine operational movement of the endoscope is limited because of the stereotactic frame fixation. We devised a new echo-guided endoscopic neurosurgery using a peel-off sheath and a steerable fiberscope.
This series included 9 patients with putaminal, 7 with subcortical, 1 with thalamic, 1 with cerebellar, and 1 with intraventricular hemorrhage. The operation was performed with the patient under general anesthesia in all but 3 cases. One or 2 burr holes were made in the forehead in 9 cases, at the coronal suture in 5, and as near as possible to the hematoma in 5. The ultrasound probe was utilized to locate the exact position of the hematoma, and to bring a peel-off sheath to the target area. The sheath was successfully located at the appropriate area of the hematoma in all cases. Under strict telescopic monitoring, intracerebral hematomas were successfully evacuated using a rigid endoscope and ordinary suction through the sheath. The tip of the sheath could be easily located at the appropriate position according to the 3-dimensional extension of the hematoma. Furthermore, the steerable fiberscope was used to evaluate the residual hematoma, remove the intraventricular hematoma and perform a third ventriculostomy. An immediate postoperative CT scan revealed that evacuation was over 90% in 13 patients, 70-90% in 3, and less than 70% in 2; the mean evacuation rate was 90.6% (94.9% in 11 recent cases). The mean operation time was 2 hours and 36 minutes.
In conclusion, this procedure is safe, minimally invasive, time-saving, and quite effective in hematoma evacuation.
