Abstract
Objectives: To describe an endoscopic technique to evacuate acute intracerebral hemorrhage (ICH) using the balanced suction-irrigation method in patients with intrinsic or iatrogenic coagulopathies. Methods: We report on our early experience with four patients with atypical ICH related to intrinsic and iatrogenic coagulopathies. In all patients, an endoscopic hematoma evacuation was performed using a navigated burrhole approach. The entry site and trajectory were planned according to the long axis of the hematoma. Results: Every operation was carried out with the aid of neuronavigation. Gross total removal of the hematoma was not intended as first line, especially if eloquent areas could be avoided. Intra-hematomal evacuation leaving minimal hematoma remnants was performed in three of four patients. We report hematoma removal rates of approximately 90%. In all patients, a significant hematoma reduction was achieved, although residues were tolerated to limit neurological damage. No re-hemorrhage was observed. Conclusion: The endoscopic technique with the aid of neuronavigation may be an appropriate method to safely evacuate ICH in the acute stage in patients with intrinsic or iatrogenic coagulopathies.
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Acknowledgment The authors specially thank Dr. T. Nagasaka, who introduced the endoscopic balanced irrigation-suction technique with a multifunctional suction cannula to the Department of Neurosurgery at Heidelberg.
Conflict of interest statement We declare that we have no conflict of interest.
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Orakcioglu, B., Uozumi, Y., Unterberg, A. (2011). Endoscopic Intra-Hematomal Evacuation of Intracerebral Hematomas – A Suitable Technique for Patients with Coagulopathies. In: Tsukahara, T., Regli, L., Hänggi, D., Turowski, B., Steiger, HJ. (eds) Trends in Neurovascular Surgery. Acta Neurochirurgica Supplementum, vol 112. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0661-7_1
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