In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

  • Endoscopic Evacuation of Basal Ganglia Hemorrhage via Keyhole Approach Using an Expendable Cannula in Comparison with Craniotomy

    Final Number:
    652

    Authors:
    Zhengcun Yan, Hengzhu Zhang, Yuping Li

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Neuroendoscopic (NE) surgery as a minimal invasive treatment for basal ganglia haemorrhage is a promising approach. The present study aims to evaluate the efficacy and safety of NE approach of applying an expendable cannula on the management of basal ganglia hemorrhage.

    Methods: In this study, we analysed the clinical and radio-graphical outcomes between NE group (21 cases) and craniotomy group (30 cases). The clinical and radio-graphical outcomes included Mortality, hematoma volume, evacuation rate, infection rates, Glasgow Coma Scale (GCS) scores, Modified Rankin Scale (mRS), and Glasgow Outcome Scale (GOS).

    Results: Mortality rate between the 2 groups did not show statistically significant differences (P=0.27). The evacuation rate was significantly higher in the NE group compared to the craniotomy group (P=0.02), and the rate of infection was lower in the NE group compared to the craniotomy group (P=0.04). Operation time (P<0.00001) and mean NICU stay (P=0.005) were significantly shorter in the NE group than in the craniotomy group. Patients in the NE group had good functional outcomes (GFO) than patients in the craniotomy (P=0.04).

    Conclusions: The results indicated NE surgery is an effective and safe approach for basal ganglia haemorrhage, and it is also suggested NE may promote a good functional recovery. However, NE approach only suit to the selected patient, and the usefulness of NE approach needs further RCTs to evaluate.

    Patient Care: applying the NE approach using expendable cannula to treat basal ganglia haemorrhage results in high evacuation rate, better functional recovery, and patients did not need cranioplasty. The results of our study further confirm the potential benefits of utilizing the NE approach. Certainly, our study has several potential limitations. This study involved a relatively small patient group. It is our hope that a larger randomized control trial will be performed to evaluate the use of the NE approach for the treatment of SICH patients.

    Learning Objectives: basal ganglia haemorrhage have begun to be approached using the technique of NE. This study presented a new expendable cannula applying in NE approach. At the first medical college affiliated with Yangzhou University, we have been applying the minimally invasive technique of NE approach to evacuate intracerebral hematomas since 2011. Here, we compared the clinical and radiological outcomes of two treatment groups (NE group vs. traditional craniotomy group). The goals of this study are to evaluate the effectiveness and safety of the NE approach to basal ganglia haemorrhage patients, as compared to the craniotomy approach, and to analyze the influences behind the surgical outcomes.

    References: 1. Broderick JP, Brott T, Tomsick T, Miller R, Huster G: Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage. Journal Of Neurosurgery 78: 188-191, 1993. 2. Kirkman MA, Mahattanakul W, Gregson BA, Mendelow AD. The effect of the results of the stich trial on the management of spontaneous supratentorial intracerebral haemorrhage in newcastle. Br J Neurosurg 22: 739-747, 2008. 3. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J: Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19: 604-607, 1988. 4 Cohen AR, Perneczky A, Rodziewicz GS, Gingold SL: Endoscope-assisted craniotomy: approach to the rostral brain stem. Neurosurgery 36: 1128-1130, 1995 5 Balami JS, Buchan AM: Complications of intracerebral haemorrhage. Lancet Neurology 11: 101-118, 2012. 6 Zuccarello M, Brott T, Derex L, Kothari R, Sauerbeck L, Tew J: Early surgical treatment for supratentorial intracerebral hemorrhage: a randomized feasibility study. Stroke 30: 1833-1839, 1999. 7 Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT: 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. 8 Menovsky T, Grotenhuis JA, de Vries J, Bartels RH: Endoscope-assisted supraorbital craniotomy for lesions of the interpeduncular fossa. Neurosurgery 44: 106-112, 1999. 9 Longatti P, Fiorindi A, Martinuzzi A: Neuroendoscopic aspiration of hematocephalus totalis: technical note. Neurosurgery 57: E409, 2005. 10 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. 11 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. Surgical Neurology 65: 547-556, 2006. 12 Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D: Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the american heart association/american stroke association stroke council, high blood pressure research council, and the quality of care and outcomes in research interdisciplinary working group. Circulation 116:e391-e413, 2007. 13 Zazulia AR, Diringer MN, Derdeyn CP, Powers WP: Progression of mass effect after intracerebral hemorrhage. Stroke 30: 1167-1173, 1999. 14 Steinke W, Sacco RL, Mohr JP, Foulkes MA, Tatemichi TK, Wolf PA: Thalamic stroke. Presentation and prognosis of infarcts and hemorrhages. Arch Neurol 49: 703-710, 1992. 15 Thompson KM, Gerlach SY, Jorn HK, Larson JM, Brott TG, Files JA: Advances in the care of patients with intracerebral hemorrhage. Mayo Clinic Proceedings 82: 987-990, 2007. 16 Arboix A, Comes E, García-Eroles L, Massons J, Oliveres M, Balcells M: Site of bleeding and early outcome in primary intracerebral hemorrhage. Acta Neurologica Scandinavica 105: 282-288, 2002. 17 Ohwaki K, Yano E, Nagashima H, Hirata M, Nakagomi T, Tamura A: Surgery for patients with severe supratentorial intracerebral hemorrhage. Neurocrit Care 5:15-20, 2006. 18 Prasad K, Mendelow AD, Gregson B: Surgery for primary supratentorial intracerebral haemorrhage. Cochrane Database Syst Rev D200, 2008. 19 Anne JM. Neurosurgery Principles And Practice, 1st ed. Stuttgart: Springer p.25-42, 2004. 20 Zhou H, Zhang Y, Liu L, Huang Y, Tang Y, Su J: Minimally invasive stereotactic puncture and thrombolysis therapy improves long-term outcome after acute intracerebral hemorrhage. Journal Of Neurology 258: 661-669, 2011. 21 Hsieh PC, Cho DY, Lee WY, Chen JT: Endoscopic evacuation of putaminal hemorrhage: how to improve the efficiency of hematoma evacuation. Surgical Neurology 2005;64:147-53. 22 Zhu H, Wang Z, Shi W. Keyhole endoscopic hematoma evacuation in patients. Turk Neurosurg 22: 294-299, 2012. 23 Kuo LT, Chen CM, Li CH, Tsai JC, Chiu HC, Liu LC: Early endoscope-assisted hematoma evacuation in patients with supratentorial intracerebral hemorrhage: case selection, surgical technique, and long-term results. Neurosurg Focus 30: E9, 2011. 24 Gaab MR. Intracerebral hemorrhage (ich) and intraventricular hemorrhage (ivh): improvement of bad prognosis by minimally invasive neurosurgery. World Neurosurg 75: 206-208, 2011. 25 Nagasaka T, Tsugeno M, Ikeda H, Okamoto T, Takagawa Y, Inao S: Balanced irrigation-suction technique with a multifunctional suction cannula and its application for intraoperative hemorrhage in endoscopic evacuation of intracerebral hematomas: technical note. Neurosurgery 65: 826-827, 2009. 26 Qiu Y, Lin Y, Tian X, Luo Q: Hypertensive intracranial hematomas: endoscopic- assisted keyhole evacuation and application of patent viewing dissector. Chin Med J (Engl) 116:195-199, 2003. 27 Chen CC, Lin HL, Cho DY: Endoscopic surgery for thalamic hemorrhage: a technical note. Surg Neurol 68:438-442, 2007. 28 Zuo Y, Cheng G, Gao DK, Zhang X, Zhen HN, Zhang W, et al. Gross-total hematoma removal of hypertensive basal ganglia hemorrhages: a longterm follow-up. J Neurol Sci 287: 100-104, 2009.

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy