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Minimally invasive endoscopic surgery for treatment of spontaneous intracerebral haematomas

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Abstract

Spontaneous intracerebral haemorrhage (ICH) is a devastating disease with a mortality rate of more than 40 % and a high morbidity rate with 10–15 % of survivors remaining fully dependent [11]. The role of surgical treatment of ICH remains a matter of controversy and ongoing investigation. Advances in neurosurgical techniques such as endoscopy and neuronavigation have been established in various fields of neurosurgery. Results of reported case series have suggested that some patients with ICH may benefit from haematoma evacuation through minimally invasive endoscopic procedures. In this article, we focus on the pathophysiologic rationales behind minimally invasive haematoma evacuation through endoscopic surgery and provide an overview of technical developments and reported patient series. In addition, the modalities of the surgical procedure at the authors’ institution are described. Controlled clinical trials are needed to evaluate the full potential and limitations of this promising technique.

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Acknowledgments

We thank Dr. T. Nagasaka (Nagoya University Graduate School of Medicine, Aichi, Japan) for introducing the endoscopic balanced irrigation-suction technique with a multifunctional suction cannula to the Department of Neurosurgery at Heidelberg University Hospital.

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Authors and Affiliations

  1. Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Christopher Beynon, Patrick Schiebel, Andreas W. Unterberg & Berk Orakcioglu

  2. Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany

    Julian Bösel

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  1. Christopher Beynon
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  2. Patrick Schiebel
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  4. Andreas W. Unterberg
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  5. Berk Orakcioglu
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Correspondence to Berk Orakcioglu.

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Comments

Waleed A. Azab, New York, USA

The manuscript by Dr. Beynon and colleagues deals with a relatively underutilized modality of surgical evacuation of spontaneous ICH. With the recent technical innovations like endoscopic transparent sheaths and irrigation-suction devices, endoscopic ICH evacuation is becoming technically more feasible. In a patient subpopulation where a short operating time and a limited yet effective procedure are evidently beneficial, endoscopic ICH evacuation seems to hold a great promise.

Michael Buchfelder, Erlangen, Germany

In this review, the authors discuss the current possibilities and limitations of endoscopic minimally invasive endoscopic surgery for spontaneous intracerebral haematomas. Whether surgical evacuation of spontaneous intracerebral haematomas at all causes an improvement of patient outcome in terms of mortality and neurological outcome and if so, which patients will profit from such an operation is an ongoing matter of controversy. During the last 30 years, gradually minimally invasive techniques, utilizing endoscopes, have been developed for haematoma evacuation that largely avoids major brain manipulation and retraction. This started with individual case report and expanded to small series.

There are several technical variations and implementation of additional technology such as neuronavigation, ultrasonic aspiration, guiding tubes and other gadgets, which are excellently described in this review. Their utility is discussed as is the usefulness of the operation as far as the clinical outcome is concerned.

Even the most sceptical reader will appreciate knowledge the availability and experience hitherto gained with this novel technique. For the final evaluation of its value for clinical practice, it seems to me that further studies, which include numerous patients, are awaited.

Yavor Enchev, Varna, Bulgaria

Currently, the treatment of spontaneous intracerebral haematomas (ICH) is controversial with respect to indications, timing, surgical techniques, and applied instruments and devices. Neuroendoscopy and neuronavigation have been proved their potential, effectiveness, reliability and advantages in most of the neurosurgical pathologies. Reasonably, similar results could be expected in the treatment of ICH. The authors thoroughly reviewed the published experience in this field. They discuss the rationales of the minimal invasive endoscopic evacuation of ICH, the existed technical directions and nuances, including their own experience, and the achieved outcomes. This rigorous and systematic review outlines the future trends of the pertinent research and the need of controlled clinical trials.

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Beynon, C., Schiebel, P., Bösel, J. et al. Minimally invasive endoscopic surgery for treatment of spontaneous intracerebral haematomas. Neurosurg Rev 38, 421–428 (2015). https://doi.org/10.1007/s10143-015-0606-6

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