Intro-neuroendoscopic technique for the treatment of parenchymal hemorrhage

Abstract

Objective To investigate the application value, technical key points and operation experience of intro-neuroendoscopic technique for removing parenchymal hematoma. Methods From June 2014 to January 2016, the clinical data of 33 patients with parenchymal hemorrhage treated with intro-neuroendoscopic technique at the Department of Emergency, Shenzhen People's Hospital, the Second Clinical Medical College of Jinan University were analyzed retrospectively. There were 24 patients with hypertensive intracerebral hemorrhage, 3 with intracerebral hemorrhage of unknown causes, 4 with traumatic cerebral hemorrhage, and 2 with intracerebral hemorrhage after tumor surgery. All patients were diagnosed with head CT. The mean hematoma volume was 45.22±8.59 cm3. The Glasgow coma score(GCS)scores were 12-5. Hematoma location: 23 patients in the basal ganglion region, 5 in the frontal lobe, 2 in the parietal lobe, and 3 in the occipital lobe. Brain CT scan was performed immediately after procedure in all patients. Results In 33 patients, the postoperative hematoma clearance rate of 20 cases was more than 90%, that of 9 cases was 60%-90%, and that of 3 cases was less than 60%. One patient was converted to craniotomy because of intraoperative bleeding. Two patients had intracranial infection after procedure, and the hematomas of 6 cases were drained with the drainage tube injection of urokinase after procedure. The mean length of operative scalp incisions was 3.0 cm(range, 2-4 cm), the diameter of bone hole was 0.8 cm to 1.1 cm, the mean intraoperative blood loss was 50 ml(range, 40 ml-100 ml), and the mean operation time was 65 min(range, 45 min-120 min). The Glasgow outcome scale(GOS)scores: 5 patients recovered well, 16 had mild disability, 12 had severe disability, and none of them died. Conclusions Intro-neuroendoscopic technique evacuation of parenchymal hematoma only needs to drill one bone hole for completing the operation. It has the advantages of convenient operation, less injury, faster recovery, and less complications. Key words: Neuroendoscopy; Cerebral hemorrhage; Treatment outcome