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Hemorrhagic Stroke: Endoscopic Aspiration

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Cerebrovascular Surgery

Part of the book series: Advances and Technical Standards in Neurosurgery ((NEUROSURGERY,volume 44))

Abstract

Intracerebral hemorrhage (ICH) and intraventricular hemorrhage (IVH) carry a very dismal prognosis. Several medical and surgical attempts have been made to reduce mortality and to improve neurological outcomes in survivors. Aggressive surgical treatment of ICH through craniotomy and microsurgical evacuation did not prove to be beneficial to these patients, compared to the best medical treatment. Similarly, the conventional treatment of IVH using an EVD is often effective in controlling ICP only initially, as it is very likely for the EVD to become obstructed by blood clots, requiring frequent replacements with a consequent increase of infection rates.

Minimally invasive techniques have been proposed to manage these cases. Some are based on fibrinolytic agents that are infused in the hemorrhagic site through catheters with a single burr hole. Others are possible thanks to the development of neuroendoscopy. Endoscopic removal of ICH through a mini-craniotomy or a single burr hole, and via a parafascicular white matter trajectory, proved to reduce mortality in this population, and further randomized trials are expected to show whether also a better neurological outcome can be obtained in survivors. Moreover, endoscopy offers the opportunity to access the ventricular system to aspirate blood clots in patients with IVH. In such cases, the restoration of patency of the entire CSF pathway has the potential to improve outcome and reduce complications and now it is believed to decrease shunt-dependency.

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Authors and Affiliations

  1. Department of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of Verona, Verona, Italy

    Alberto Feletti

  2. Unit of Neurosurgery, Spedali Civili, University of Brescia, Brescia, Italy

    Alessandro Fiorindi

Authors
  1. Alberto Feletti
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  2. Alessandro Fiorindi
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Correspondence to Alberto Feletti .

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Editors and Affiliations

  1. Department of Neurosurgery Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya-shi, Aichi, Japan

    Yoko Kato

  2. Department of Neurosurgery, Jawahar Lal Nehru Medical College Aligarh Muslim University, Aligarh, Uttar Pradesh, India

    Ahmed Ansari

5.1 Electronic Supplementary Material

IVH aspiration from the lateral and the anterior part of the third ventricle (Feletti et al., How I do it: flexible endoscopic aspiration of intraventricular hemorrhage. Acta Neurochir 2020, 162:3141–3146. Published with permission) (MP4 40476 kb)

IVH aspiration from the posterior part of the third ventricle, the cerebral aqueduct, and the fourth ventricle (Feletti et al., How I do it: flexible endoscopic aspiration of intraventricular hemorrhage. Acta Neurochir 2020, 162:3141–3146. Published with permission) (MP4 54704 kb)

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Feletti, A., Fiorindi, A. (2022). Hemorrhagic Stroke: Endoscopic Aspiration. In: Kato, Y., Ansari, A. (eds) Cerebrovascular Surgery. Advances and Technical Standards in Neurosurgery, vol 44. Springer, Cham. https://doi.org/10.1007/978-3-030-87649-4_5

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  • DOI: https://doi.org/10.1007/978-3-030-87649-4_5

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  • Online ISBN: 978-3-030-87649-4

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