Supraorbital approach in surgery for lateral intracerebral hematoma

Abstract

Aim: to present the experience of using the technique of endoscopic aspiration (EA) of lateral intracerebral hematomas (ICH) through the mini-supraorbital approach. Material and methods. From 2019 to 2021 at the Sklifosovsky Institute for Emergency Medicine, 12 patients with lateral ICH underwent EA of the ICH using a mini-supraorbital approach. There were 7 men (58.3 %) and 5 women (41.7 %). The mean age of the patients was 53.2±6.8 years. According to the Glasgow Coma Scale (GCS), the level of consciousness during hospitalization corresponded to 15 points in 4 (33.3 %) patients, and 11‑14 points — in 8 (66.7 %) patients. The average volume of lateral ICH was 45.3±17.4 cm3 (from 28 to 84 cm3). The average duration of the surgical intervention was within 4.2±2.1 days. The operations were performed using STORZ endoscopic equipment. Ventriculoscopes and Gaab trocars were used in 3 cases, and transparent endoscopic ports with a diameter of 8 mm and 4 mm endoscopes were applied in 9 cases. The operations were performed under the control of BrainLab frameless neuronavigation. Results. The average duration of operations was 93±18 minutes. EA through the mini-supraorbital approach provides the removal from 51 to 91 % of the intracerebral hematoma volume, 73.3±16.6 % on average. There were no complications during the operation associated with the use of the approach. The outcomes were of 0‑2 in 2 (16.7 %) patients, 3‑5 — in 8 (66.7 %), and 6 — in 2 (16.7 %) patients according to the modified Rankin Scale. Conclusion. Supraorbital approach allows efficient removal of lateral ICH. The close passage of the access trajectory to the base of the anterior cranial fossa is not an obstacle and does not reduce the radicality of blood clots removal from the ICH cavity. However, the lateral ICH removal through the supraorbital approach requires the use of frameless navigation during the entire main stage of the operation, and instead of a metal trocar, it is recommended to use a transparent endoscopic port.