脳内出血治療における内視鏡的血腫除去術の役割

Abstract

Endoscopic hematoma evacuation is an established treatment option for patients with intracerebral hemorrhage (ICH). Although it has the advantages of being less invasive than craniotomy and more effective than conservative therapy, its role and indication in ICH treatment are still controversial. We retrospectively reviewed 34 cases with ICH treated by endoscopic surgery. ICH patients with mild-to-moderate consciousness disturbance were treated by endoscopic surgery. Of 34 patients, 24 (70.6%) exhibited significant improvement in their consciousness level immediately after surgery. Of 29 patients other than those with cerebellar hemorrhage, 12 (41.4%) showed significant functional recovery in their motor weakness on discharge. The extent of improvement in consciousness level was positively correlated to that in motor weakness. The removal rate of hematoma was 68.4±31.7% on average and was not correlated to the extent of functional recovery. Two patients experienced re-bleeding after operation and had poor functional prognoses. Of these, 1 was administered anticoagulants and the other was given antiplatelets before operation. These data suggest that endoscopic hematoma evacuation may be beneficial for ICH patients with mild-to-moderate consciousness disturbance by promptly improving their consciousness level, leading to the final functional recovery. On the other hand, endoscopic hematoma evacuation has the potential problem of low hemostatic ability. The operative indication for patients taking an anticoagulant or antiplatelet drugs should be cautiously determined.