Combined minimal invasive techniques in deep supratentorial intracerebral haematomas

Minimal invasive techniques (MIT) like microscopy, stereotaxy, endoscopy and neuronavigation facilitate and improve neurosurgical results and reduce the operative trauma. We report the combined employment of these techniques and the results obtained in our department during the last 7 years in 95 consecutive patients with supratentorial deep located intracerebral haematomas (ICHs). Thirty-six deteriorating patients with deep ICHs under 30 cm (3) volume associated to intraventricular bleeding, were treated early (first 24 hours after bleeding) with neuronavigation guided stereotactic lysis, using multiplanar targets (1 to 3). Microsurgical clot aspiration through an enlarged burr-hole was frequently combined with endoscope- or neuronavigation-assisted evacuation within the first 6 hours after bleeding for the rest of the deteriorating patients with ICHs larger than 30 cm (3). A 1.2 cm narrow surgical corridor assured the least injury to vital cortical areas, tracts and blood vessels. In 86 cases the clots were adequately removed (non-measurable rest) with a reduced morbid mortality (13.8 and 8.6 as well as 23.3 and 16.9 for stereotactic and microscopic MIT, respectively). In our experience, the use of combined MIT adapted to the surgical urgency of the individual patient reduces the operative trauma and improves the accuracy for the access to the clot allowing an adequate haematoma evacuation and a satisfactory outcome in most of the cases.