Endoscopic evacuation of hypertensive putaminal hemorrhage guided by the 3D reconstructed CT scan: A preliminary report

Abstract

Objective The minimally invasive procedure is the trend in nowadays neurosurgical techniques. We designed a new targeting method using three-dimensional (3D) reconstructed CT images combining neuroendoscope for hypertensive putaminal hemorrhage (HPH). Methods Eleven consecutive unconscious patients with a significant volume of HPH were treated with neuroendoscope via a selected frontal or temporal trephination. All the CT images were operated and reconstructed by an independent neuroradiologist for measuring the selected frontal or temporal entry point, depth of penetrating path, and surgical trajectory on the basis of the plane formed by bilateral orbitomeatal lines. The nasion and the external auditory meatus were the reference points for the selected frontal and temporal trephinations respectively. All the surgical trajectories were designed as perpendicular to the underground for minimizing the possibility of human errors after aseptic surgical draping. The intra-operatively sonography was routinely used after trephination for confirmation of the planned surgical path and early detection of possible enlarged hematoma. Results Ten of the 11 patients regained consciousness postoperatively without complications. All the patients had an accurate trajectory of penetrating path and the average hematoma evacuation rate was 82% (83% for frontal approach and 81% for temporal approach). Conclusion Use of the 3D reconstructed CT imaging technique combining neuroendoscope may add as a minimally invasive, economic, and timesaving way for targeting HPH. It also serves as a reliable and useful alternative for hospitals without stereotactic or navigating modalities. However, further prospective studies were needed to clarify its efficacy and safety compared to conventional surgeries.