Single-port endoscopic removal of intraventricular hemorrhage or tumor of the brain: A technical note

Abstract

Background/Purpose. Although endoscopic surgery is a minimally invasive procedure, it is a relatively inefficient method for removing intraventricular hemorrhage (IVH) and intraventricular tumors. To improve the efficiency of endoscopic surgery, we used either a polypropylene tube or a 3-mL syringe tube combined with a working channel endoscope to remove IVH and an intraventricular tumor. Methods. From January 2005 to October 2005, four patients with IVH and one patient with intraventricular tumor were treated by endoscopic surgery in our hospital. During surgery, we experimented with two different endoscopic sheaths to approach the intra ventricular lesions. The indications for surgery in patients with IVH were consciousness disturbance with acute hydrocephalus and a hematoma volume＞20 mL. Results. In the patient with neurocytoma, the tumor was totally resected. In the four patients with IVH, the preoperative Graeb scores ranged from 8 to 12 (median 10 ) and the postoperative Graeb scores ranged from 3 to 5 (median 4), representing a reduction of 67%. The preoperative IVH ventriculocranial ratio ranged from 0.35 to 0.43 and the postoperative ventriculocranial ratio ranged from 0.14 to 0.29, representing a reduction of 36%. At 6-month follow-up, the mortality rate was 25%; none of the patients showed evidence of shunt-dependent hydrocephalus. The mean Glascow outcome scale at 6-month follow-up was 3.5±1.9. Conclusion. A working channel endoscope combined with either a polypropylene endoscopic sheath or a 3-mL syringe endoscopic sheath facilitates the removal of IVH and intraventricular tumors in endoscopic surgery.