脳内出血に対する軟性鏡手術と硬性鏡手術の比較

Abstract

While a rigid-type endoscope has been used for the surgery of intracerebral hemorrhage, a flexible fiberscopie is more maneuverable. But flexible fiberscopic surgery for intracerebral hemorrhage is challenging in terms of visual resolution of the operative field. We compared the results of this new method with that of our conventional method using a rigid-type endoscope. A flexible fiberscope with an outer diameter of 4.8-mm was inserted into hematoma cavity by free hands, or in some cases under CT-guided stereotaxy. An irrigation-suction system is used to facilitate aspiration of hematoma with hard clots. The problem of interference of the visual field with clots was solved by water irrigation of the endoscopic lens. The operation time was comparable to that of our past surgery using a rigid endoscope (58 min vs. 53 min), and the mean removal rate of hematoma was also similar to that of the rigid endoscopic surgery (77% vs. 86%). Although the results of the flexible fiberscopic surgery were comparable to that of the rigid endoscopic surgery, effective hemostat instruments are unavailable. For this reason, we select this surgery only for patients in subacute stage in which hemostat process is completed. This method is only in the developmental stage, and advances in instruments are necessary to establish it.