Endoscopic intra-hematomal evacuation of intracerebral hematomas - a suitable technique for patients with...

To describe an endoscopic technique to evacuate acute intracerebral hemorrhage (ICH) using the balanced suction-irrigation method in patients with intrinsic or iatrogenic coagulopathies.

We report on our early experience with four patients with atypical ICH related to intrinsic and iatrogenic coagulopathies. In all patients, an endoscopic hematoma evacuation was performed using a navigated burrhole approach. The entry site and trajectory were planned according to the long axis of the hematoma.

Every operation was carried out with the aid of neuronavigation. Gross total removal of the hematoma was not intended as first line, especially if eloquent areas could be avoided. Intra-hematomal evacuation leaving minimal hematoma remnants was performed in three of four patients. We report hematoma removal rates of approximately 90%. In all patients, a significant hematoma reduction was achieved, although residues were tolerated to limit neurological damage. No re-hemorrhage was observed.

The endoscopic technique with the aid of neuronavigation may be an appropriate method to safely evacuate ICH in the acute stage in patients with intrinsic or iatrogenic coagulopathies.