Affiliation:
1. Renmin Hospital of Wuhan University
2. People's Hospital of Dongxihu District
Abstract
Abstract
Objective
To introduce a new “three-in-one technique” surgical approach of "stereotactic aspiration + neuroendoscopy + decompressive craniectomy” for spontaneous supratentorial intracerebral hemorrhage (SSICH) with tentorial herniation patients and to explore its preliminary application.
Methods
On our previous “two-in-one technique” operation, we further combined decompressive craniectomy to form a special surgical approach for SSICH with tentorial herniation patients. The operation included three steps: 1. Burr hole and aspirate partially clot to rapidly decrease intracranial pressure (ICP); 2. Remove the residual hematoma and stop the bleeding under neuroendoscope; 3. Decompressive craniectomy for further complete decompression. Clinical data of 17 patients with SSICH and cerebral hernia who underwent this approach in our department from January 2019 to February 2022 were collected, and time to access hematoma, hematoma evacuate rate and the outcome were analyzed.
Results
All procedures were successfully completed and the average access time to hematoma was 4.8 minutes in “three-in-one technique” group, which was much less than in craniotomy group (36.3 minutes) and neuroendoscopy group (9.9 minutes). Among the 17 patients, 3 died, 7 give up, 5 improved and 2 clinical cured. The poor prognosis (Death + Give up ) was 58.8% which was much better than traditional craniotomy group in previously published studies.
Conclusions
This “three-in-one technique” surgical approach combines the advantages of rapid decompression by stereotactic aspiration, full decompression and minimizing iatrogenic brain injury by neuroendoscope, complete decompression by decompressive craniectomy, which is a beneficial attempt for SSICH with tentorial herniation patients.
Publisher
Research Square Platform LLC
Reference19 articles.
1. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis;Asch CJ;Lancet Neurol,2010
2. Long-term prognosis after intracerebral haemorrhage: systematic review and meta-analysis;Poon MT;J Neurol Neurosurg Psychiatry,2014
3. Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial;Anderson CS;Lancet Neurol,2008
4. Treatment of intracerebral haemorrhage;Mayer SA;Lancet Neurol,2005
5. Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality;Broderick JP;Stroke,1993