Department of Neurosurgery, National Taiwan University Hospital, Yun-Lin, Taiwan.
Neurosurg Focus. 2011 Apr;30(4):E9. doi: 10.3171/2011.2.FOCUS10313.
Currently, the effectiveness of minimally invasive evacuation of intracerebral hemorrhage (ICH) utilizing the endoscopic method is uncertain and the technique is considered investigational. The authors analyzed their experience with this method in terms of case selection, surgical technique, and long-term results.
The authors performed a retrospective analysis of the clinical and radiographic data obtained in 68 patients treated with endoscope-assisted ICH evacuation. Rebleeding, morbidity, and mortality were recorded as primary end points. Hematoma evacuation rate was calculated by comparing the pre- and postoperative CT scans. Glasgow Coma Scale scores and scores on the extended Glasgow Outcome Scale (GOSE) were recorded at the 6-month postoperative follow-up. The technical aspect of this report explains details of the procedure, the instruments that are used, the methods for hemostasis, and the role of hemostatic agents in the management of intraoperative hemorrhage. The pertinent literature was reviewed and summarized.
All surgeries were performed within 12 hours of ictus, and 84% of the surgeries were performed within 4 hours. The mortality rate was 5.9%, and surgery-related morbidity occurred in 3 cases (4.4%). The hematoma evacuation rate was 93% overall-96% in the putaminal group, 86% in the thalamic group, and 98% in the subcortical group. The rebleeding rate was 1.5%. The mean operative time was 85 minutes, and the average blood loss was 56 ml. The mean GOSE score was 4.9 at 6-month follow-up. The authors acknowledge the limitations of these preliminary results in a small number of patients.
The data suggest that early endoscope-assisted ICH evacuation is safe and effective in the management of supratentorial ICH. The rebleeding, morbidity, and mortality rates are low compared with rates reported in the literature for the traditional craniotomy method. This study also showed that early and complete evacuation of ICH may lead to improved outcomes in selected patients. However, the safety and efficacy of endoscope-assisted ICH evacuation should be further investigated in a large, prospective, randomized trial.
目前，利用内镜方法微创清除脑出血（ICH）的效果尚不确定，该技术仍处于研究阶段。作者分析了他们在病例选择、手术技术和长期结果方面的经验。
作者对 68 例接受内镜辅助 ICH 清除术治疗的患者的临床和影像学资料进行了回顾性分析。记录再出血、发病率和死亡率作为主要终点。通过比较术前和术后 CT 扫描计算血肿清除率。格拉斯哥昏迷评分（GCS）和扩展格拉斯哥预后评分（GOSE）在术后 6 个月的随访中进行记录。本报告的技术方面解释了该程序的详细信息、使用的仪器、止血方法以及止血剂在术中出血管理中的作用。回顾并总结了相关文献。
所有手术均在发病后 12 小时内进行，84%的手术在发病后 4 小时内进行。死亡率为 5.9%，手术相关发病率为 3 例（4.4%）。血肿清除率总体为 93%-壳核组为 96%，丘脑组为 86%，皮质下组为 98%。再出血率为 1.5%。手术时间平均为 85 分钟，平均失血量为 56ml。平均 GOSE 评分为 6 个月随访时的 4.9。作者承认这些初步结果在少数患者中存在局限性。
数据表明，早期内镜辅助 ICH 清除术在治疗幕上 ICH 方面是安全有效的。与传统开颅术方法的文献报道相比，再出血、发病率和死亡率较低。本研究还表明，早期和完全清除 ICH 可能会使选定患者的结局得到改善。然而，内镜辅助 ICH 清除术的安全性和有效性仍需在大型、前瞻性、随机试验中进一步研究。
