• Daiki Uchida, Hirokazu Nakatogawa, Tomohiro Yamazoe, Chikanori Inenaga, and Tokutaro Tanaka.
• Department of Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu, Japan. Electronic address: d-uchida@sis.seirei.or.jp.
• World Neurosurg. 2020 Jan 1; 133: 1-7.

BackgroundRecent studies have confirmed the effectiveness of minimally invasive endoscopic surgery for intracerebral hematoma (ICH). However, improvements are needed because incomplete hematoma removal may offset the surgical benefits of the technique. We describe a technique of neuroendoscopic surgery using an image detectable sheath, intraoperative computed tomography (iCT) scan, and a navigation system.MethodsThis is a retrospective study of 15 consecutive patients with spontaneous ICH who received neuroendoscopic surgery. During the surgery, a transparent sheath was fastened tightly to the scalp with 3.0 nylon. The patient's head was covered with a sterilized vinyl sheet and subsequent iCT scan visualized the orientation of the endoscopic sheath and the extent of residual hematoma, allowing the surgeon to decide to continue to remove the hematoma or to finish the treatment.ResultsThe median hematoma evacuation rate was 93% (interquartile range, 82.2%-95.9%). The Glasgow Coma Scale score of all patients significantly improved at 1 week after the operation (P < 0.05). No complications associated with the procedure were observed.ConclusionsThe combination of our techniques improves accuracy and safety of minimally invasive surgical evacuation of hematoma. Performing surgery with iCT scan also improves the spatial recognition of surgeons and therefore may be of educational value.Copyright © 2019 Elsevier Inc. All rights reserved.

29 keywords...

hide…