Neuroendoscope-Assisted Technique for Evacuation of Intracerebral Hematoma with Penetration into the Ventricular System

Abstract

Introduction: In patients with intracerebral hematoma (ICH), with penetration into the ventricular system neurosurgical treatment is a matter of choice and methods. Aim: The aim of the study was to evaluate the effectiveness of the authors’minimal-invasive neuroendoscope-assisted technique for evacuation of ICH with ventricular penetration. Material and Methods: The study was conducted based on a thorough analysis of the literature. Punctiform craniectomy and modification of the authors of transparent trocars were used for endoscope-assisted evacuation of ICH with penetration into the ventricular system in 10 patients, in 7 patients were performed both ICH evacuation and placement of external ventricular drainage and in 13 patients was inserted only ventricular drainage. The patients were followed-up clinically and radiologically as morbidity, mortality, and rebleeding rates were specified. Results: Timing of the procedure was within 36 hours of clinical manifestations. The ICH distribution was: subcortical group- 20% (6 patients), putaminal group- 16.66% (5 patients), thalamic group- 50% (15 patients) and cerebellar group- 13.33% (4 patients). The mean operative time was 45 minutes. The mortality rate was 66.66% (20 patients), and the morbidity associated with surgery was observed in 5 patients (16.66%). The percentage of repeat bleeding was 23.33% (7 patients). Tracheotomies were necessary in 50% (15 patients). Conclusion: The authors’ neuroendoscope-assisted technique for evacuation of intracerebral hematoma (ICH) with penetration into the ventricular system represents reasonable option for neurosurgical treatment.