Results of endoscopic aspiration of hypertensive intracerebral hematomas depending on the surgery technique

Abstract

Aim: to conduct a comparative analysis of the invasiveness, radicality of operations and treatment outcomes, depending on the options for the technique of endoscopic aspiration of hypertensive intracerebral hematomas (EA ICH). Material and methods. At the Sklifosovsky Institute for Emergency Medicine, EA ICH was performed in 131 patients with haemorrhagic stroke from 2006 to 2020. There were 89 men (67.9%) and 42 women (32.1%). The mean age of the patients was 55.1±12.5 years (from 20 to 87 years). According to the Glasgow Coma Scale (GCS) [28], the level of consciousness during hospitalization corresponded to 15 points in 42 (32.1%) patients, 11-14 points - in 78 (59.5%), 9-10 points - in 9 (6.9), 6-8 points - in 2 (1.5%) patients. In 124 (94.7%) patients, ICH was supratentorial, in 7 (5.3%) patients - subtentorial. The average volume of supratentorial ICH was 48.3±20.1 cm³ (from 6 to 131 cm³), subtentorial - 14.3±3.5 cm³ (from 9 to 18 cm³). The average term of performing the surgery was 5.5±7.5 days. ICH removal in the aquatic environment was performed through single-channel (6.5 mm) and multi-channel (6.0 mm) trocars of ventriculoscopes; removal of ICH in the air was achieved through a single-channel trocar (6.5 mm), wide (from 12 to 21 mm) and narrow (8.0 mm) transparent ports. CT brain scan was performed during the first day after the operation. The outcomes were assessed on the 30th day according to the modified Rankin scale. Results. The most radical ICH removal was achieved with the use of wide transparent ports, while the least number of recurrences was after operations through narrow transparent ports, and the tendency to achieve better functional outcomes was obtained when the method of ICH removing in the aquatic environment was refused in favor of EA in the air environment. Conclusion. The trend in achieving better functional outcomes can be traced in patients after surgeries in the air environment. Operations through wide ports provide a more radical removal of blood clots, while operations through a trocar and narrow ports in the air allow for the lowest rate of ICH recurrences.