Minimally invasive management of spontaneous supratentorial intracerebral lobar hemorrhages by a "home made" endoscopic strategy. The evangelic doctrine of "venite ad me" allied to the legacy of King Leonida.

Author:Alberio N, Cicero S, Iacopino DG, Giammalva GR, Visocchi M, Olivi A, Francaviglia N, Battaglia R, Spitaleri A, Lipani R, Ruggeri L, Alessandrello R, Cinquemani A, Maugeri R
Published on:World Neurosurg. 2018 Nov 24

Presentation

In questo studio italiano multicentrico vengono presentati i risultati di una serie consecutiva di pazienti sottoposti a rimozione dei coaguli ematici in pazienti affetti da emorragia cerebrale lobare mediante una tecnica innovativa eseguita sotto ingrandimento della lente senza l'uso del microscopio o dell'endoscopio, la cui sorgente luminosa è stata utilizzata solo per schiarire la cavità di lavoro. Questa strategia può essere impiegata in urgenza e in background meno sviluppati a causa della ridotta domanda di risorse e della sua curva di apprendimento più breve, con un buon risultato tale come il classico approccio endoscopico

Abstract

BACKGROUND: While the incidence of intracerebral haemorrhage (ICH) appear to be increasing over the year, its prognosis still remains dismal . Although no consensus about the management of ICH has be found, minimal invasive surgery should limit - when not avoid - the intra operative parenchymal damage. At this regard, we present a novel modified "home made" approach, aimed to shorten the operative time and minimize the corticectomy and brain manipulation, with our clinical series.

METHODS: From 2008 to 2017, 53 patients (32 male and 21 female, mean age 63,8 years old) were admitted to our Department of Neurosurgery and treated for a surgical lobar ICH. A modified suction tube coupled with the endoscope light source was used. The clot evacuation was performed under the loupe magnification without either the use of the microscope or the endoscope, whose light source was only used to lighten the working cavity.

RESULTS: The mean hematoma volume was 69.2 ml preoperatively (range 40-100) and 12.1 ml (range 0-20) postoperatively, with a mean clot evacuation of 84.3% (range 60-100%). The mean post operative GCS was 11.6, with an improvement of 14% from the admission score (mean 9.2).

CONCLUSIONS: Our clinical series not only upholds the effectiveness of endoscopic clot evacuation in surgical ICH but also provides an efficient technique to be used in urgency and in less-developed backgrounds due to its reduced demand of resources and its shorter learning curve, with a good outcome such as the classical endoscopic approach.

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