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Updated: Sep 19, 2025
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Triple sheath neuroendoscopic combination technique for managing complete intraventricular hemorrhage casting in
Zohaib Shafiq1, Long Zhou1, Xi Jiang2
1Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China.
Insights
The triple sheath neuroendoscopic combination technique (TSNCT) shows promise for complete intraventricular hemorrhage (IVH) casting, achieving high hematoma clearance and improved neurological function. Further research is needed to confirm its efficacy in neurosurgery.
Area of Science:
- Neurosurgery
- Minimally Invasive Procedures
- Cerebrovascular Diseases
Background:
- Complete intraventricular hemorrhage (IVH) casting presents significant management challenges.
- Standard treatments like endoscopic hematoma removal and external ventricular drainage (EVD) have limitations in severe cases.
Purpose of the Study:
- To evaluate the efficacy of the triple sheath neuroendoscopic combination technique (TSNCT) for complete IVH casting.
- To compare TSNCT with standard endoscopic hematoma removal and EVD.
Main Methods:
- Retrospective analysis of five patients with complete IVH casting.
- Two patients treated with TSNCT, two with standard endoscopic hematoma removal, and one with EVD.
- Review of preoperative/postoperative imaging, neuroendoscopic video, and clinical data.
Main Results:
- TSNCT achieved a mean hematoma clearance rate of 93.5%, superior to standard endoscopic removal (91.7%) and EVD (27.2%).
- TSNCT patients demonstrated greater neurological improvement (mean GCS increase of 7 points) compared to standard endoscopic removal (3 points) and EVD (no improvement).
- TSNCT showed potential for fewer complications in this small cohort.
Conclusions:
- TSNCT offers a novel approach to overcome anatomical challenges in complete IVH casting.
- The technique enhances surgical precision and shows potential for improved patient outcomes.
- Larger cohort studies are required to validate findings and standardize TSNCT application.
Objective:
To evaluate the efficacy of the triple sheath neuroendoscopic combination technique (TSNCT) compared to standard endoscopic hematoma removal and external ventricular drainage (EVD) for managing complete intraventricular hemorrhage (IVH) casting in patients with cerebral hemorrhage.
Methods:
A retrospective analysis was conducted on five patients with complete IVH casting treated at our institution between 2023 and 2024, including two treated with TSNCT, two with standard endoscopic hematoma removal, and one with EVD. Preoperative and postoperative imaging, intraoperative neuroendoscopic video, and clinical data were reviewed. The TSNCT involves an outer sheath for ventricular access, a middle sheath for maneuverability, and a mini sheath designed to navigate the midbrain aqueduct.
Results:
TSNCT enabled near-complete evacuation of hematomas, including in the midbrain aqueduct, achieving a mean hematoma clearance rate of 93.5% in the two TSNCT cases, compared to 91.7% for standard endoscopic removal and 27.2% for EVD. TSNCT cases showed greater neurological improvement [mean Glasgow Coma Scale (GCS) increase of 7 points] than standard endoscopic removal (3 points) and EVD (no improvement). TSNCT addresses high mortality associated with severe hemorrhage involving all ventricular chambers, with fewer complications in this small cohort.
Conclusion:
TSNCT offers a novel approach to overcome anatomical challenges in complete IVH casting, enhancing surgical precision and showing potential for improved patient outcomes. Further research with larger cohorts is needed to validate these preliminary findings and standardize its application in neurosurgical practice.
