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  • Using local hemostatic agents for hemostasis during minimally invasive endoscopic-assisted evacuation of intracerebral hemorrhage

    Final Number:

    Te Fu Chen, Lu-Ting Kuo MD PhD; Huan-Chih Wang, Chien-Min Chen; Jui-Chang Tsai; Abel Po-Hao Huang MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Endoscope-assisted evacuation of intracerebral hemorrhage (ICH) has been shown to be safe and effective with less morbidity and mortality compared to craniotomy. However, the limited working space might hinder meticulous hemostasis. Local hemostatic agents has been applied in brain surgery. We present our experience in using these agents for hemostasis during minimally-invasive surgery for ICH. To date, this is the first series that describes the safety and efficacy of local hemostatic agents used in minimally invasive surgery for ICH.

    Methods: A retrospective analysis was performed. 45 patients were treated with endoscope-assisted hematoma evacuation followed by injection of local hemostatic agents. Rebleeding and mortality were recorded as primary endpoints. The hematoma evacuation rate was calculated by comparing of the pre- and post-operative brain computed tomography (CT) scans. Extended Glasgow Outcome Scale (GOS-E) was recorded at the 6-month post-operative follow-up. The technical aspect of this report expatiate details of the procedure and the used instruments.

    Results: 45 patients with ICH were included; 23 cases of putaminal type, 18 of thalamic type, and 4 of subcortical type. The mortality rate was 6.7%. The hematoma evacuation rate was 81.34%. The rebleeding rate was 6.7%. The mean operative time was 100 minutes, and the average blood loss was 84 mL. The mean GOS-E score was 4.56 at 6-month post-operative follow-up. There were limitations of these preliminary results in such a small number of patients.

    Conclusions: Endoscope-assisted hematoma evacuation followed by injection of local hemostatic agents is a safe and effective method. The rebleeding rate was lower than the craniotomy method. The mortality rate is only 6.7% and the morbidity rate is low. However, a large, prospective, randomized trial is mandatory to confirmed this conclusion.

    Patient Care: This new technique is effective in reducing mortality and morbidity of ICH patients. It may also shorten operative time and minimize adjacent brain damage.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the techniques of using local hemostatic agent for hemostasis during minimally-invasive surgery for intracerebral hemorrhage; 2) Describe the steps of endoscope-assisted hematoma evacuation.

    References: 1. Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, et al: Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet 365:387–397, 2005 2. Zuccarello M, Brott T, Derex L, Kothari R, Sauerbeck L, Tew J, et al: Early surgical treatment for supratentorial intracerebral hemorrhage: a randomized feasibility study. Stroke 30:1833–1839, 1999 3. Cho DY, Chen CC, Chang CS, Lee WY, Tso M: Endoscopic surgery for spontaneous basal ganglia hemorrhage: comparing endoscopic surgery, stereotactic aspiration, and craniotomy in noncomatose patients. Surg Neurol 65:547–556, 2006 4. Nagasaka T, Tsugeno M, Ikeda H, Okamoto T, Inao S, Wakabayashi T: Early recovery and better evacuation rate in neuroendoscopic surgery for spontaneous intracerebral hemorrhage using a multifunctional cannula: preliminary study in comparison with craniotomy. J Stroke Cerebrovasc Dis 20:208–213, 2011

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