Clinical and Radiological Outcomes of Endoscopic evacuation ofIntracerebral Hematoma

Introduction: Spontaneous intracerebral hemorrhage (ICH) is a sudden event with an extremely high rate of mortality and disability . It accounts for about 22% of strokes and over 4 million people affected yearly. The most important risk factor for spontaneous ICH is uncontrolled hypertension which is responsible for about 65% of cases. Management of spontaneous ICH is still controversial. Surgical ICH could be managed by standard open craniotomy which is effective in adequate evacuation and hemostasis.This approach may cause damage to uninjured brain. In contrast, recent studies on minimally invasive measures, including endoscopic evacuation, have designated such surgical techniques as safe and effective in patients with operable ICH.

Methods: This is a prospective controlled study conducted on patients admitted to emergency unit with supra-tentorial intracerebral hematoma indicated for neurosurgical intervention and operated upon by endoscopic evacuation. Clinical and functional outcomes were assessed mainly Glasgow coma scale (GCS), speech improvement, motor power and skills. Radiological outcomes using follow up computed tomography (CT) brain on postoperative day 1, 3, and 7. In hospital stay and mortality were main cornerstones in this study.

Results: We included twenty-six patients who underwent endoscopic evacuation of hematoma with mean age, 52+/-13; 18 males and 8 females, with median volume of ICH 36cc. The median operative time was 90 minutes (range: 60-120 minutes).The median duration of ICU stay was 5 days (range: 2-14 days). GCS improved significantly from 6 to 13 through one week of in hospital stay. The median Glasgow Outcome Scale score was 3 after 6 months. The 1st day post operative ICH volume ranged from (5-10 cc). Two cases showed recollection, only one case required re-evacuation through traditional open craniotomy. Mortality rate was 3.8%.

Conclusion : With the introduction of the minimally invasive techniques and the evolution of the neuroendoscopy and hemostatic agents, the median operative time, blood loss and hospital stay have been significantly decreased. This represents an important advancement in treating spontaneous supratentorial ICH, and provides promising results that can be expected in the future.