Patient selection criteria and preliminary outcome of the first 20 endoscopic evacuation of intracerebral hematoma in a tertiary hospital center.

Abstract

Background: Evacuation of intracerebral hemorrhage (ICH) using endoscopic, minimally invasive surgery is becoming the main technique in the surgical treatment of this devastating disease, given the overall improved outcomes reported. We report our experience with patient selection and preliminary results of the first 20 patients with ICH treated with endoscopic evacuation.

Methods: A retrospective analysis of intraparenchymal and/or intraventricular hemorrhage cases, treated from 2018 to 2020 was performed. Patient characteristics, technical details, and surgical outcomes (favorable, modified Rankin scale [mRS] 0-2; unfavorable, mRS 3-5; death, and mRS 6) were analyzed and discussed.

Results: Six (30.0%) cases of IVH, 10 (50.0%) of intraparenchymal hematoma (IP), and 4 (20.0%) of IP&IVH were treated using the endoscopic technique. The mean age was 50.8 [17.6] years, with a male predominance of 60.0% (n = 12). Analysis of variance testing of the mean difference confirmed a favorable outcome when the hemorrhage was limited to the IP location (mean mRS score at 6 months was 1.90 (95% confidence interval [CI] [1.37-2.43], P = 0.032). However, there was an unfavorable outcome when blood was inside the ventricles: IVH (mean mRS at 6 months was 4.17 (95% CI [2.02-6.31], P = 0.032) and IP&IVH (mean mRS at 6 months was 5.0 (95% CI [1.81-8.18], P = 0.032).

Conclusion: The endoscopic intracranial hematoma evacuation technique can achieve a high evacuation rate with shorter surgical duration and acceptable morbidity, encouraging the transition from classical craniotomy in selected patients. Sufficient knowledge and training in endoscopic techniques can be achieved through a short learning curve.