Image guided endoscopic evacuation of supratentorial intracerebral hematoma by keyhole approach:an analysis of 119 patients

Xu Yongge; Wang Yan; Zhang Guozhen; Su Hui; Xia Xiaoyu; Song Zhao

doi:10.11850/j.issn.1009-122X.2015.07.009

Abstract：Objective To explore the surgical outcome and techniques of minimally invasive endoscopic surgery for spontaneous supratentorial hemorrhage. Methods Clinical data of 119 patients with spontaneous supratentorial hemorrhage were analyzed retrospectively, including 84 patients with hemorrhage in the basal ganglia, 14 in the thalamic area, 14 in different brain lobes and 7 in the ventricles. All the patients underwent image-guided endoscopic evacuation of supratentorial intracerebral hematoma by keyhole approach under general anesthesia. The surgical keyhole approach was chosen according to the position of hemorrhage. Results All the patients tolerated surgery without major intra-surgical complication. The duration time from onset to surgery was 3.5 to 74 h with the median time of 8 h. The surgical duration lasted for 45 to 115 min with the median time of 61 min. The rate of hematoma evacuation was -10.0% to 100% with the median rate of 92.8%. The residual hematoma volume was 0 to 58 ml with the median volume of 2 ml. Ten patients (8.4%) received surgery again. Five patients died and the clinical mortality rate was 4.2%. Duration of hospitalization was 5 to 61 d with the median time of 14 d. GCS scores at discharge was improved by-2 to 6 points with the median score of 3.9 points. Conclusions Image-guided endoscopic evacuation method for supratentorial hemorrhage can completely evacuate the hematoma, achieve reliable hemostasis and minimal trauma and protect the functional area well with low rate of post-operative complications. It can be a recommended method for supratentorial intracerebral hematoma with a volume more than 20 ml without cerebral hernia. The critical points for reducing rebleeding rate are that conformation of no bleeding before surgery, hemostasis maintain under increased blood pressure during surgery and strict control of blood pressure after surgery.