[Endoscopic treatment of the spontaneous intracerebral hematomas].

Background and Purpose: Surgical evacuation of spontaneous intracerebral hematomas (ICH) performed in a traditional way usually increases primary brain tissue damage due to the hemorrhage. On the other hand, symptoms of the intracerebral pressure and secondary brain tissue destruction close to the hematoma are the basis for making a decision about surgical treatment. In order to limit surgical trauma we started research to evaluate the usefulness of endoscopic surgery in the treatment of ICH.
Material and Methods: Twenty three cases were included in the study. Patients with consciousness disorders and/or focal neurological deficit and different systemic diseases were qualified for endoscopic evacuation. The diagnosis of hematoma was based on computed tomography (CT). ICHs were lobar and in certain cases they extended to the basal ganglia. All patients were operated on within one week from the onset of symptoms. Neuroendoscope was introduced to the hematoma cavity through the burr hole and the puncture of the cerebral surface over the hematoma. The hematoma was evacuated by fractionated rinsing. Bigger clots were fragmentized but those which were adjacent to the cavity wall were left. Postoperative assessment of the hematoma evacuation was based on CT performed immediately and in the second week after surgery.
Results: Total evacuation of the ICH was achieved in 6 patients, and its volume was reduced in 17 cases. Symptoms of brain edema resolved in all patients. A significant trend to reduce focal neurological deficits was observed: 16 patients improved and 3 remained unchanged. Four patients died.
Conclusions: Endoscopic surgery allows a complete hematoma evacuation or reduction of its volume, reduces symptoms of brain edema and accelerates the improvement of focal neurological deficits.