Endoscopic evacuation of supratentorial hematoma: A hemostatic strategy for surgeons

Endoscopic hematoma evacuation has become well received for its high evacuation rate in patients with intracerebral hematoma. Effective hemostatic procedure is the key to the success of the procedure. Any single method cannot solve all kinds of intraoperative bleeding, The key to hemostasis is to identify the type of bleeding and take the best hemostasis method during endoscopic surgery. In our study, sixty-two intracerebral hemorrhage patients who underwent endoscopic hematoma evacuations were analyzed. Intraoperative bleeding was graded as Grades 0, 1, 2, and 3 based on characteristics of bleeding. A hemostatic strategy was created from the grading system. The efficiency was evaluated by operation time, evacuation rate, and re-bleeding rate after surgery. Procedure safety was evaluated by mortality rate and postoperative complications. We found that endoscopic removal of putamen hematoma was more prone to intraoperative bleeding (P = .00). Active bleeding occurred in early operative stage and errhysis happen in later stage (P = .00). Average evacuation rate was 95.61% and the mortality rate was 3.23%. The mean Glasgow outcome scale (GOS) score at 6-month follow-up was 3.77 ± 1.12. No patient experienced postoperative re-bleeding. These findings indicated that most patients will experience different degrees of intraoperative bleeding during endoscopic hematoma evacuation. A hemostatic strategy based on intraoperative bleeding grade resulted in efficiency and safety.