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Intracerebral haemorrhage (ICH) evacuation by minimally invasive neurosurgery (MIN) techniques
EANS Academy. Resch K. Sep 27, 2019; 276154; EP01137
Abstract
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Introduction: STICH trials did not take notice of minimal invasive neurosurgery (MIN) strategies and techniques.
What clinical trials fail to detect is clearly known by pathophysiology: Haemorrhages need to be evacuated. The major issue seams to be the surgical trauma. To study the status quo by clinical trials will not be helpful
We elaborated a MIN technique with high effectiveness and applied it up to now in over 260 cases. We present a retrospectively analysis of the 56 recent cases.
Material and method: This MIN concept combined several techniques to assist microsurgery: High-end neuro-sonography with small probes („burr-hole-probe/ALOKA/Hitachi) and mouth tracking of the microscope, both mandatory. Additionally we added endoscopy (Wolf, Aesculap, Storz) and LASER (Th-YAG Revolix). Sealing technique for dura was always used (Tachosil/Takeda).
More than 260 patients underwent this application by the presenting author. A series of the 56 recent cases, 26 female and 29 male, 69.1 y (40 - 83)(1 child excl.), was analysed.
The approaches varied from burr-hole to 1€ or 2€ in size depending from the imaging findings and expected difficulties.
Results: Compared with STICH the 'favourable outcome' was pushed from 26% to 86%.
In all cases it was possible to evacuate the hematoma within 1 hour and the hematoma evacuation decreased the ICP to normal levels. Clinical results were excellent in lobar bleedings with isochoric before surgery. Large and deep-seated haemorrhages needed longer recovery time but in all cases postop CT showed fast reduction of peri-focal edema and ICP.
Conclusion: Combination of ultrasound, mouth tracking, endoscopy, LASER and sealing technique enabled evacuation of all type of hematoma minimal invasively and very effectively in less than one hour. Ultrasound real-time control detected all types and locations of bleeding causes. The evacuation amount and the reaction of the brain were under visual control.
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