Department of Neurosurgery, Icahn School of Medicine at Mount Sinai.
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai;
J Vis Exp. 2021 Oct 15(176). doi: 10.3791/58217.
Intracerebral hemorrhage (ICH) is a subtype of stroke with high mortality and poor functional outcomes, largely because there are no evidence-based treatment options for this devastating disease process. In the past decade, a number of minimally invasive surgeries have emerged to address this issue, one of which is endoscopic evacuation. Stereotactic ICH Underwater Blood Aspiration (SCUBA) is a novel endoscopic evacuation technique performed in a fluid-filled cavity using an aspiration system to provide an additional degree of freedom during the procedure. The SCUBA procedure utilizes a suction device, endoscope, and sheath and is divided into two phases. The first phase involves maximal aspiration and minimal irrigation to decrease clot burden. The second phase involves increasing irrigation for visibility, decreasing aspiration strength for targeted aspiration without disturbing the cavity wall, and cauterizing any bleeding vessels. Using the endoscope and aspiration wand, this technique aims to maximize hematoma evacuation while minimizing collateral damage to the surrounding brain. Advantages of the SCUBA technique include the use of a low-profile endoscopic sheath minimizing brain disruption and improved visualization with a fluid-filled cavity rather than an air-filled one.
脑出血（ICH）是一种具有高死亡率和不良功能结局的中风亚型，主要是因为针对这种破坏性疾病过程没有循证治疗选择。在过去十年中，已经出现了许多微创手术来解决这个问题，其中之一是内镜清除术。立体定向 ICH 水下血液抽吸（SCUBA）是一种新型内镜清除技术，在充满液体的腔室内使用抽吸系统进行操作，为手术提供额外的自由度。SCUBA 手术使用抽吸装置、内镜和护套，分为两个阶段。第一阶段包括最大抽吸和最小冲洗，以减少血栓负担。第二阶段包括增加冲洗以提高可视性，在不干扰腔壁的情况下降低抽吸强度，有针对性地抽吸，以及对任何出血血管进行烧灼。该技术使用内镜和抽吸管，旨在最大程度地清除血肿，同时将对周围大脑的继发损伤最小化。SCUBA 技术的优点包括使用低轮廓内镜护套，最大限度地减少脑破坏，以及在充满液体的腔室内而不是在充满空气的腔室内改善可视化。
