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[Endoscopic evacuation of intraventricular hematoma and third ventriculostomy]
K Anzai1, K Kamiyama, T Sasaki
1Department of Neurosurgery, Nakamura Memorial Hospital, Hokkaido.
Insights
Endoscopic evacuation of intraventricular hematoma effectively removes blood clots and prevents hydrocephalus in patients with associated intracerebral hemorrhage. This minimally invasive approach offers a safe and efficient treatment option, reducing hospitalization time.
Area of Science:
- Neurosurgery
- Minimally Invasive Procedures
- Neuroendoscopy
Background:
- Intraventricular hematoma (IVH) associated with intracerebral hemorrhage (ICH) poses significant management challenges.
- Obstructive hydrocephalus is a common complication requiring timely intervention.
- Traditional surgical approaches may involve significant invasiveness.
Observation:
- A steerable endoscope was utilized for direct aspiration and evacuation of intraventricular hematomas.
- The procedure involved accessing the lateral ventricle contralaterally to the ICH, followed by evacuation from the third ventricle, aqueduct, and fourth ventricle.
- Third ventriculostomy was performed to address acute obstructive hydrocephalus, with subsequent septostomy and ipsilateral lateral ventricle hematoma evacuation.
Findings:
- Successful endoscopic evacuation of intraventricular hematomas was achieved in all three cases.
- No major complications were encountered during the procedures.
- Significant hematoma removal was confirmed post-operatively.
Implications:
- Endoscopic evacuation of IVH associated with ICH is a viable and effective treatment.
- This technique facilitates sufficient hematoma removal, potentially reducing hospitalization duration.
- The procedure aids in preventing subsequent hydrocephalus, improving patient outcomes.
Abstract:
We described our experience of three cases treated with endoscopic evacuation of intraventricular hematoma and third ventriculostomy for a tight intraventricular hematoma associated with intracerebral hemorrhage. A steerable endoscope was introduced into the anterior horn of the lateral ventricle contralaterally to the intracerebral hemorrhage, through a 14 Fr. peel-away sheath. First, the hematoma in the lateral ventricle contralateral to the hemorrhage was evacuated by direct aspiration using a syringe connected to the operative channel of the endoscope, and evacuation of the hematoma was subsequently carried on the third ventricle, aqueduct and the fourth ventricle. After the evacuation of the intraventricular hematoma, third ventriculostomy was performed for acute obstructive hydrocephalus. Finally, the procedure was completed with septostomy and evacuation of the hematoma in the lateral ventricle ipsilateral to the hemorrhage. Sufficient evacuation of the hematoma was obtained in all cases and no major complications were encountered. We conclude that for patients with intraventricular hematoma associated with intracerebral hemorrhage endoscopic evacuation of intraventricular hematoma brings about sufficient removal of hematoma, reduction of hospitalization time and prevention of subsequent hydrocephalus.