The Exploration Of Neuroendoscopic Evacuation Of Hypertensive Intracerebral Hemorrhage

Objective：Evacuation of hypertensive intracerebral hematoma with craniotomy isassociated with high rates of mortality and morbidity. Some retrospective studies showed noobvious advantages in the surgery group vs the medical group for patients suffered fromhemorrhagic stroke. Evacuation by endoscopic surgery through a small burr hole is lessinvasive but is relatively inefficient and unsafe because of poor imaging in hematoma.Modified endoscopic procedures for removing intracerebral hematoma was based onendoscopic skull base techniques and a polypropylene endoscopic sheath. The endoscopicimage was produced clearly in air environment with high quality. The feasibility andcurative effectiveness of image-guided endoscopic evacuation of hypertensive intracerebralhemorrhage needs further evaluation.Method：20patients underwent endoscopic evacuation of hypertensive intracerebralhemorrhage. The clinical evaluation included pre-and postoperative Glasgow Coma Scale(GCS) score of neural function deficits(NFDS)and CT scan, clot removing efficiency,Complete absorption time of hematoma, and Barthel Index（BI）6months later.Results：Postoperative imaging showed the mean hematoma evacuation rate was84.5±11.44%24hours after surgery. There was no intracranial infection and secondaryhemorrhage after surgery in all cases. Pre-and postoperative GCS was8.85±2.37、10.5±2.26,NFDS was31.15±4.70、23.9±5.34respectively. No hydrocephalus occurredwithin3months after surgery. All patients were followed up for six months. According tothe Barthel Index,5patients scored excellent（25%）,5were poor（25%）.Conclusion：Neuroendoscopic surgery for intracerebral hematoma with modifiedinstruments is minimally invasive and effective procedure with direct-vision, lowcomplication and mortality. It also produces good neurological outcome and could be anew therapeutic option for hypertensive intracerebral hematomas.