Abstract
Background Spontaneous intracerebral hemorrhages (ICHs) cause significant morbidity and mortality.
Traditional open surgical management strategies offer limited benefit except for the
most superficial hemorrhages in select patients. Recent reports suggest that endoscopic
approaches may improve outcomes, particularly for deep subcortical hemorrhages. However,
the management of these patients remains controversial. We reviewed our experience
using endoscopic port surgery to identify characteristics that may predict acceptable
outcomes.
Materials and Methods We completed a retrospective chart and imaging review of patients who underwent endoscopic
port surgery for evacuation of spontaneous ICH at a single center. Data were gathered
regarding patient demographics, hemorrhage locations, operative findings, and clinical
outcomes.
Results From 2007 to 2011, 18 patients underwent evacuation of spontaneous intracerebral
hematomas using an endoscopic port. The mean age in years was 62 years (range, 43–84
years). Six of 18 patients (33%) died before discharge, and 2 others (11%) died after
at least 1 month of survival. Of 12 initial survivors, all were discharged to a rehabilitation
or nursing facility. Complete hematoma evacuation was achieved in 7 of 18 patients,
with the remaining 11 having a partial evacuation. The patients who died (n = 6) before discharge were statistically more likely to have a left-sided hemorrhage,
partial evacuation, or older age than the survivors; death at least 1 month after
evacuation was additionally associated with greater preoperative hematoma volumes.
Conclusions Our series demonstrates that endoscopic port surgery for acute intracerebral hematoma
evacuation has the ability to achieve significant decompression of large and deep-seated
hematomas. Patient age, extent of evacuation, laterality, and preoperative hematoma
volume appear to influence patient outcome. Most overall outcomes remain poor. Future
studies are necessary to determine if surgical evacuation is in fact superior to best
medical treatment and if so, to validate, refute, or further identify characteristics
that define surgical candidates.
Keywords
endoscopic port surgery - hematoma - minimally invasive - outcomes - characteristics
