Minimally Invasive Management of Spontaneous Supratentorial Intracerebral Lobar Hemorrhages by a "Homemade" Endoscopic Strategy: The Evangelical Doctrine of "Venite ad Me" Allied to the Legacy of King Leonida.

Abstract

Although the incidence of intracerebral hemorrhage (ICH) has appeared to be increasing over the years, its prognosis remains dismal. No consensus has yet been reached regarding the management of ICH; however, minimally invasive surgery should limit, if not avoid, intraoperative parenchymal damage. Therefore, we have presented a novel, modified "homemade" approach aimed to shorten the operative time and minimize the corticectomy and brain manipulation. From 2008 to 2017, 53 patients (32 men and 21 women; mean age, 63.8 years) were admitted to our neurosurgery department and surgically treated for a lobar ICH. A modified suction tube, coupled with the endoscope light source, was used. Clot evacuation was performed under loupe magnification without the use of the microscope or endoscope. The light source of the latter was only used to provide light in the working cavity. The mean hematoma volume was 69.2 mL (range, 40-100) preoperatively and 12.1 mL (range, 0-20) postoperatively, with a mean clot evacuation of 84.3% (range, 60%-100%). The mean postoperative Glasgow coma scale score was 11.6, with an improvement of 14% from the admission score (mean, 9.2). The results from our clinical series have shown the effectiveness of endoscopic clot evacuation in surgical ICH. In addition, we have demonstrated an efficient technique that can be used in urgent cases and in less-developed areas owing to its reduced demand on resources and its shorter learning curve. The outcomes were good and comparable to those with the classical endoscopic approach.