Endoscopic Evacuation of Intracerebral Hematoma Using a Modified 2.5-mL Syringe-Based Transparent Working Sheath.

Abstract

Self-made syringe sheaths with larger outer diameters, such as 5-mL and 10-mL syringes, may theoretically increase the risk of white-matter disruption. Therefore, we describe a transparent working sheath based on a 2.5-mL syringe for neuroendoscopic evacuation of intracerebral hematoma. This retrospective, single-centre technical note included 49 non-consecutive patients who underwent neuroendoscopic hematoma evacuation assisted by the modified sheath between June 2024 and December 2025. 3D Slicer and neuronavigation were used for localization. The coordinated two-surgeon hemostatic technique was used within the sheath, wherein indirect electrocoagulation hemostasis was performed using an aspirator. Evaluated outcomes included technical, radiological, clinical, and safety outcomes. The surgeons' subjective perceptions were assessed through a multidimensional questionnaire survey. A total of 49 patients were enrolled. The median preoperative hematoma volume was 38 mL (IQR 31-51). Twenty-one patients (43%) presented with GCS ≤ 8. Hematomas were located in the putamen, thalamus, lobar regions, cerebellum, and caudate. The median evacuation rate was 98% (IQR 97-99). Pulmonary infection occurred in 23/49 patients (47%). One patient developed subdural hematoma in the nonoperative area after surgery; no in situ rebleeding or death occurred. Favourable outcomes were observed in 69% (mRS 0-2) and 80% (mRS 0-3) at 6 months. The questionnaire survey reflected the surgeons' subjective perceptions regarding intraoperative handling and tissue protection. The transparent working sheath modified from a 2.5-mL syringe was inexpensive and may be effective. Selected patients may be considered for surgical evacuation depending on hematoma characteristics and clinical status.