被殻出血に対する神経内視鏡の有効性

Abstract

The indications for surgical treatment in spontaneous intracerebral hemorrhage has been controversial. The objective of this study is to evaluate the less invasive hematoma evacuation technique by using the endoscope improving the functional outcome for the patient with spontaneous putaminal hemorrhage. Materials and Methods: We retrospectively reviewed patients with spontaneous putaminal hemorrhage treated in Juntendo University Shizuoka Hospital between 2001 and 2011. A treatment group using endoscope (n=44) was compared with a patient group treated by the conventional surgery (n=14) or conservative therapy (n=21). In all patients, the hematoma volume prior to surgery was between 30 ml and 59 ml. Surgical hematoma evacuation had been performed within 72 hours after onset. Patient severity was recorded in ICH scores. The outcome was evaluated by modified Rankin scale (m-RS) and the 30-day mortality in each group. Results: The patient populations did not statistically differ in any of the groups. Patient severity was similar in all three groups. The functional outcome in the endoscopic group was significantly better than in both the craniotomy surgery group and the conservative treatment group (p<0.05). Thirty-day mortality in the conservative group was higher than in the surgical treatment groups. Conclusion: The neuro-endoscope is safe and useful for the surgical treatment of intracerebral hemorrhage. As optimal surgical indications for the endoscopic hematoma evacuation, the hematoma volume should be from 30 ml to 59 ml in patients with moderate neurological deficits. As further study, a randomized controlled trial must be conducted in the future.