Endoscopic treatment of hypertensive intracerebral hemorrhage: A technical review

Zhao, Yining; Chen, Xiaolei

doi:10.1016/j.cdtm.2016.11.002

Cited by 16 publications

(10 citation statements)

References 57 publications

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“…Compared with craniotomy, endoscopic evacuation of ICH has several advantages, such as minimal invasive procedure, fewer complications, higher magnification, shorter operation period, and better prognosis 5,9,10 . It has a broad prospect in the surgical treatment of HICH 11 . In the last two decades, the endoscopic evacuation rate of intracerebral hematomas has been rather low, because the narrow hematoma cavity can obstruct the endoscopic view 6,12 .…”

Section: Discussionmentioning

confidence: 99%

3D-printed model-guided endoscopic evacuation for basal ganglia hemorrhage

Zhang¹,

Cheng

Zhou

et al. 2020

Sci Rep

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The purpose of this study was to investigate the effectiveness and practicality of 3D-printed modelguided endoscopic surgery for the treatment of basal ganglia hemorrhage. The authors retrospectively analyzed the data of all patients who underwent endoscopic evacuation of basal ganglia hemorrhage in the Department of Neurosurgery at Dalang Hospital and Shipai Hospital between December 2017 and February 2019. Twelve patients, in whom the 3D-printed model guidance was used for endoscopic evacuation, were included in this investigation. Using 3D reconstructed technology, we designed the appropriate surgical approach. Then, an individualized facial model with the guide orifice was printed by a 3D printer. Further, the 3D-printed model was employed to guide the insertion of the endoscope sheath. As a result, the average evacuation rate was 97.2% (range 90.1-100.0%). The GCS and mRS score were improved in each patient from admission to discharge examination. All patients had a good prognosis based on their functional independence measure (FIM) scores at the 6-month follow-up. The 3D-printed model-guided endoscopic evacuation was effective and safe for basal ganglia hemorrhage. This technique deserves further investigation to determine its role in intracerebral hemorrhage management. Hypertensive intracerebral hemorrhage (HICH) is a very common neurosurgical disease disorder with a poor prognosis and outcome. The hematoma is generally located in the brain parenchyma such as the basal ganglia 1-3. Recently, endoscopic surgery for the hematoma evacuation has gradually replaced craniotomy to minimize brain injury 4,5. Endoscopic techniques is a new method of minimally invasive operation that have the advantages of less trauma, fewer complications, and better prognosis. Compared with traditional craniotomy, the accurate localization of the hematoma is more important in endoscopic surgeries. Precise insertion of the puncturing needle or sheath is the crucial factor of the accomplishment of operation 6,7. Hence, we need a low-cost and easy-to-follow technique to localize the deep-seated hematoma. 3D printing technology is based on the original digital imaging and communications in medicine (DICOM) data of CT and 3D software modeling. On the basis of this technology, the shape and position of hematomas in patients are analyzed, and the surgical approach is designed to avoid important positions, such as those of the venous sinus, the functional area, and the forehead sinus 8. According to the facial features of the patients, an individualized facial model with the guide orifice is designed and printed by a 3D printer. In the hematoma puncture process, the puncture angle and the puncture position can be fixed through the guide orifice, which reduces the tissue injury, caused by the inaccurate localization and repeated puncture. This method for the treatment of HICH by neuroendoscopy is personalized and more accurate than the conventionally used ones.

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Section: Discussionmentioning

confidence: 99%

3D-printed model-guided endoscopic evacuation for basal ganglia hemorrhage

Zhang¹,

Cheng

Zhou

et al. 2020

Sci Rep

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“…[ 8 , 13 , 20 ] As a promising type of MIS, the effect of endoscopic surgery in ICH appears favorable in some studies. [ 7 , 15 , 24 - 26 ] Since it is less invasive, endoscopic surgery has been considered as the most convenient treatment for ICH,[ 27 ] and its use is currently being validated in the INVEST trial. [ 4 ] Results of recent studies support the use of endoscopic surgery,[ 7 , 11 , 15 , 26 ] but, to the best of our knowledge, to date, there are no reports focusing on elderly patients, especially comparing the difference between “early” and “late” elderly patients.…”

Section: Introductionmentioning

confidence: 99%

Significance of endoscopic hematoma evacuation in elderly patients with spontaneous putaminal hemorrhage

Fujita¹,

Ueno²,

Watanabe³

et al. 2021

Surgical Neurology International

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Background: The efficacy of endoscopic surgery for spontaneous intracerebral hemorrhages (ICH) has been previously reported, but differences in the effect between early and late elderlies remain unclear. Methods: Ninety-seven patients diagnosed with putaminal hemorrhage (age, ≥65 years; hematoma volume, ≥30 mL) were included in this retrospective analysis and separated into three treatment groups: craniotomy surgery (CR), endoscopic surgery (EN), and non-surgical (NS) groups. The patients were additionally subdivided into two groups according to age: patients aged 65–74 years (“early elderlies”) and patients aged ≥75 years (“late elderlies”). Their clinical data and outcomes at discharge were compared using statistical analyses. Results: The CR and the EN groups were associated with lower mortality rates (P < 0.001), lower modified Rankin Scale (mRS; P = 0.007), and lower National Institutes of Health Stroke Scale (NIHSS; P = 0.029) compared to the NS group. Early elderlies in the CR and EN groups with ICH scores of 3 also had significantly better outcomes (P = 0.001). The proportion of patients with mRS ≤ 4 was highest in the early elderlies of the EN group (P = 0.553). Although significant differences in the change of NIHSS scores between the early and late elderlies was not observed, significantly improved NIHSS scores were observed in the EN group compared to the NS group, even in the late elderlies (P = 0.037). Conclusion: The evacuation of deep-seated intracranial hematomas using the endoscope might improve functional outcomes and mortality, regardless of age.

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“…The neuroendoscopy-based minimally invasive technologies applied to treat ICH are becoming increasingly mature. Some studies [ 23 , 24 , 25 ] have found that neuroendoscopic minimally invasive surgery for hematoma removal has the advantages of less trauma, shorter operation time, less intraoperative blood loss, and higher hematoma clearance rate. However, the MISTIE II and III studies [ 8 , 9 ] found that minimally invasive surgery did not significantly improve neurological function outcomes.…”

Section: Discussionmentioning

confidence: 99%

A new surgical method of treatment spontaneous intracranial hemorrhage

Wang

Zhang

et al. 2021

Translational Neuroscience

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Objective This study aimed to determine the safety and effectiveness of DTI-assisted neuroendoscopy for treating intracranial hemorrhage (ICH). Methods This retrospective study included clinical data from 260 patients with spontaneous supratentorial ICH who received neuroendoscopic hematoma removal. Patients were separated into groups based on the surgery method they received: DTI-assisted neuroendoscopy (69 cases) and standard neuroendoscopy (191 cases). All patients were followed up for 6 months. Multivariate logistic regression analyzed the risk factors affecting the prognosis of patients. The outcomes of the two groups were compared using Kaplan–Meier survival curves. Results The prognostic modified Rankin Scale (mRS) score was significantly better (P = 0.027) in the DTI-assisted neuroendoscopy group than in the standard neuroendoscopy group. Logistic regression analysis showed that DTI-assisted neuroendoscopy is an independent protective factor for a favorable outcome (model 1: odds ratio [OR] = 0.42, P = 0.015; model 2: OR = 0.40, P = 0.013). Kaplan–Meier survival curves were used to show that the median time for a favorable outcome was 66 days (95% confidence interval [CI] = 48.50–83.50 days) in the DTI-assisted neuroendoscopy group and 104 days (95% CI = 75.55–132.45 days) in the standard neuroendoscopy group. Log-rank testing showed that the DTI-assisted neuroendoscopy group had a lower pulmonary infection rate (χ 2 = 4.706, P = 0.030) and a better prognosis (χ 2 = 5.223, P = 0.022) than the standard neuroendoscopy group. The survival rate did not differ significantly between the DTI-assisted neuroendoscopy group and the standard neuroendoscopy group (P > 0.05). Conclusions The use of DTI in neuroendoscopic hematoma removal can significantly improve neurological function outcomes in patients, but it does not significantly affect the mortality of patients.

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Endoscopic treatment of hypertensive intracerebral hemorrhage: A technical review

Cited by 16 publications

References 57 publications

3D-printed model-guided endoscopic evacuation for basal ganglia hemorrhage

3D-printed model-guided endoscopic evacuation for basal ganglia hemorrhage

Significance of endoscopic hematoma evacuation in elderly patients with spontaneous putaminal hemorrhage

A new surgical method of treatment spontaneous intracranial hemorrhage

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