Introduction: The modality of surgical treatment for intracranial and intraventricular hemorrhages (ICH, IVH) had been shifting from the craniotomy to the endoscopic surgery in Japan with original innovation of the endoscopic equipments and the techniques.
Methods: Endoscopic procedure: A transparent tubular sheath of 8 to 10 mm in the outer diameter which had been developed in Japan is inserted into the hematoma through a burr hole, and a rigid endoscope is introduced into the sheath together with a suction tube. Under direct visualization of the hematoma by the endoscope, the hematoma is evacuated by the suction. To treat the IVH, the sheath is inserted to the anterior horn through a frontal burr hole usually placed for the ventricular drainage. The thalamic hemorrhages with ventricular perforation can be treated through the ventricular route.
Results: A total of 209 ICH and 143 IVH cases were treated in AMU hospital and the related institutes since October 2006 to December 2014; putaminal 89, thalamic 54, lobar/subcortical 41, cerebellar 14, caudate 11 cases. The IVH were related to ICH in 82, subarachnoid hemorrhage in 31, Moyamoya disease in 19, arteriovenous malformation in 4 cases, and the causes of IVH were unknown in 7 cases. The surgical complications were experienced in 3.9% (12 cases), and 3 cases (0.9%) were fatal (2 postoperative hemorrhages related to Moyamoya disease and myelodysplastic syndrome, and 1 case with ventriculitis).
Conclusions: The endoscopic surgery provides the same results as the craniotomy regarding ICH removal, by less invasive procedures requiring one burr hole and remarkably shorter operative time (about 1 to 2 hours). This procedure had extended the surgical indication to the lesion related to IVH. The IVH can be treated effectively without use of thrombolytic agents which may cause rebleeding, and the period of ventricular drainage became shorter.
Patient Care: The functional prognosis may improve in the patients treated by the endoscopic treatment (evaluation of surgical results by EBM mothod is required).
Learning Objectives: The current status of ICH/IVH treatment maximally utilizing the advantages of neuroendoscopy will be reported.