Objective: We developed a new clinical surgery approach termed the "two-in-one technique" that combines neuroendoscopy with stereotactic aspiration for spontaneous supratentorial intracerebral hemorrhage (SSICH). This study was designed to explore its feasibility, safety, and effectiveness.
Methods: Starting in December 2018, 40 patients (Group A) were prospectively studied after undergoing this new technique. The time to access the hematoma, average hematoma evacuation rate, and Glasgow Coma Scale (GCS) improvement at discharge were analyzed. Two patients had increased intracranial pressure (ICP) caused by the transparent plastic sheath and two other patients experienced ICP decreases following the two-in-one technique. The control groups included 42 patients treated by stereotactic aspiration (Group B) and 40 cases treated by neuroendoscopy (Group C).
Results: All procedures were successfully completed. The average access time to hematoma was 4.675 minutes in Group A, which was much less than in Group C (10.20 minutes). The average hematoma evacuation rate was 91.91% which was much higher than Group B (44.2%), and the average GCS improvement at discharge was 3.82. The ICP increased sharply when the transparent plastic sheath was inserted, while ICP decreased significantly when using the new technique.
Conclusions: The two-in-one technique can decrease ICP quickly and avoid transient ICP increases caused by transparent sheath insertion. This approach can also avoid the shortcomings of stereotactic aspiration and offers the advantages of neuroendoscopy. More importantly, it was effective and safe, making it a promising method for the surgical treatment of SSICH.
Keywords: Spontaneous supratentorial intracerebral hemorrhage; minimally invasive surgery; transcranial neuroendoscopic approach.
AJTR Copyright © 2022.