Endoscopic Hematoma Evacuation for Hypertensive Cerebellar Hemorrhage

Abstract

Object: The management of spontaneous cerebral hemorrhage remains controversial, particularly the surgical indications. Endoscopic surgery was evaluated for the treatment of spontaneous cerebellar hemorrhage. Methods: The records of 69 patients with hypertensive cerebral hemorrhage were retrospectively reviewed. Patients treated by endoscopic surgery (n = 10) were compared with patients treated by conventional surgical hematoma evacuation (n = 10) under the same surgical indications. Results: The surgical procedure time, duration of ventricular drainage, extent of hematoma evacuation, necessity for cerebrospinal fluid (CSF) shunt, surgical complications, and outcome at discharge and at 3 months after onset were compared. The extent of hematoma evacuation was greater in the endoscopic group (95.2 %) than in the craniectomy group (90.6 %) but without significant difference. The endoscopic technique (64.5 min) took significantly less time than the craniectomy method (230.6 min, p < 0.0001). The period of ventricular drainage was significantly shorter in the endoscopic group (2.6 days) compared to the craniectomy group (12.3 days, p < 0.01). CSF shunt surgery was required in no patient in the endoscopic group compared to three in the craniectomy group. Conclusion: Endoscopic hematoma evacuation is a rapid, effective, and safe technique for the removal of hypertensive cerebellar hemorrhage. Reduction of the mass effect can be accomplished with low risk of recurrent hemorrhage. Release of obstructive hydrocephalus in the early stage may improve the patient's outcome and decrease the requirement for permanent shunt emplacement.

Cerebellar hemorrhage - endoscope - surgical indication - minimally invasive surgery

References

• 1 Mendelow A D, Gregson B A, Fernandes H M, Murray G D, Teasdale G M, Hope D T. et al . Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomized trial.  Lancet. 2005;  29 387-397
• 2 Kobayashi S, Sato A, Kageyama Y, Nakamura H, Watanabe Y, Yamaura A. Treatment of hypertensive cerebellar hemorrhage - surgical or conservative management?.  Neurosurgery. 1994;  34 246-250
• 3 Little J R, Tubman D E, Ethier R. Cerebellar hemorrhage in adults. Diagnosis by computerized tomography.  J Neurosurg. 1978;  48 575-579
• 4 Waidhauser E, Hamburger C, Marguth F. Neurosurgical management of cerebellar hemorrhage.  Neurosurg Rev. 1990;  13 211-217
• 5 Kirollos R W, Tyagi A K, Ross S A, Hille P T van, Marks P V. Management of spontaneous cerebellar hematomas: a prospective treatment protocol.  Neurosurgery. 2001;  49 1378-1386
• 6 Auer L M, Deinsberger W, Niederkorn K, Gell G, Kleinert R, Schneider G. et al . Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study.  J Neurosurg. 1989;  70 530-535
• 7 Hsieh P C, Cho D Y, Lee W Y, Chen J T. Endoscopic evacuation of putaminal hemorrhage: how to improve the efficiency of hematoma evacuation.  Surg Neurol. 2005;  64 147-153
• 8 Nakano T, Ohkuma H, Ebina K, Suzuki S. Neuroendoscopic surgery for intracerebral hemorrhage - comparison with traditional therapies.  Minim Invas Neurosurg. 2003;  46 278-283
• 9 Nishihara T, Teraoka A, Morita A, Ueki K, Takai K, Kirino T. A transparent sheath for endoscopic surgery and its application in surgical evacuation of spontaneous intracerebral hematomas. Technical note.  J Neurosurg. 2000;  92 1053-1055
• 10 Hemphill 3rd J C, Bonovich D C, Besmertis L, Manley G T, Johnston S C. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage.  Stroke. 2001;  32 891-897
• 11 Takanashi Y, Shinonaga M. Usefulness of aspiration surgery for elderly patients with hypertensive cerebellar hemorrhage.  No To Shinkei. 1998;  50 751-754 (in Japanese)
• 12 Yokote H, Komai N, Nakai E, Ueno M, Hayashi S, Terashita T. Stereotactic evacuation of hypertensive cerebellar hemorrhage using plasminogen activator.  No Shinkei Geka. 1989;  17 421-426 (in Japanese)
• 13 Marquardt G, Wolff R, Seifert V. Multiple target aspiration technique for subacute stereotactic aspiration of hematomas within the basal ganglia.  Surg Neurol. 2003;  60 8-13
• 14 Lippitz B E, Mayfrank L, Spetzger U, Warnke J P, Bertalanffy H, Gilsbach J M. Lysis of basal ganglia haematoma with recombinant tissue plasminogen activator (rtPA) after stereotactic aspiration: initial results.  Acta Neurochir (Wien). 1994;  127 157-160
• 15 Niizuma H, Otsuki T, Yonemitsu T, Kitahara M, Katakura R, Suzuki J. Experiences with CT-guided stereotaxic biopsies in 121 cases.  Acta Neurochir Suppl (Wien). 1988;  42 157-160