Download PDF
Minim Invasive Neurosurg 2004; 47(5): 294-298
DOI: 10.1055/s-2004-830073
Original Article
© Georg Thieme Verlag Stuttgart · New York

Combined Minimal Invasive Techniques in Deep Supratentorial Intracerebral Haematomas

M.  N.  Carvi y Nievas1 , E.  Haas1 , H.-G.  Höllerhage1 , H.  Schneider1 , A.  Pöllath1 , E.  Archavlis1
  • 1Neurosurgical Clinic, Städtische Kliniken Frankfurt a. M.-Höchst, Germany
Further Information

Publication History

Publication Date:
02 December 2004 (online)

    Permissions and Reprints

Abstract

Minimal invasive techniques (MIT) like microscopy, stereotaxy, endoscopy and neuronavigation facilitate and improve neurosurgical results and reduce the operative trauma. We report the combined employment of these techniques and the results obtained in our department during the last 7 years in 95 consecutive patients with supratentorial deep located intracerebral haematomas (ICHs). Thirty-six deteriorating patients with deep ICHs under 30 cm3 volume associated to intraventricular bleeding, were treated early (first 24 hours after bleeding) with neuronavigation guided stereotactic lysis, using multiplanar targets (1 to 3). Microsurgical clot aspiration through an enlarged burr-hole was frequently combined with endoscope- or neuronavigation-assisted evacuation within the first 6 hours after bleeding for the rest of the deteriorating patients with ICHs larger than 30 cm3. A 1.2 cm narrow surgical corridor assured the least injury to vital cortical areas, tracts and blood vessels. In 86 cases the clots were adequately removed (non-measurable rest) with a reduced morbid mortality (13.8 and 8.6 as well as 23.3 and 16.9 for stereotactic and microscopic MIT, respectively). In our experience, the use of combined MIT adapted to the surgical urgency of the individual patient reduces the operative trauma and improves the accuracy for the access to the clot allowing an adequate haematoma evacuation and a satisfactory outcome in most of the cases.

Key words

Microsurgery - neuronavigation - stereotaxy - neuroendoscopy - supratentorial haematomas

  • 1 Gregson B A, Mendelow A D. for the STICH Investigators . International variations in surgical practice for spontaneous intracerebral hemorrhage.  Stroke. 2003;  34 2593-2598
    CrossrefPubMedGoogle Scholar
  • 2 McKissock W, Richardson A, Taylor J. Primary intracerebral hemorrhage: a controlled trial of surgical and conservative treatment in 180 unselected cases.  Lancet. 1961;  2 221-226
    PubMedGoogle Scholar
  • 3 Zuccarello M, Brott T, Derex L, Kothari R, Sauerbeck L, Tew J, Loveren H van, Yeh H-S. Early surgical treatment for supratentorial intracerebral hemorrhage.  Stroke. 1999;  30 1833-1839
    CrossrefPubMedGoogle Scholar
  • 4 Tomsick T, Pancioli A, Khoury J, Broderick J. Early surgical treatment for supratentorial intracerebral hemorrhage. A randomized feasibility study.  Stroke. 1999;  30 1833-1839
    CrossrefPubMedGoogle Scholar
  • 5 Fayad P, Awad I. Surgery for intracerebral hemorrhage.  Neurology. 1998;  51 69-73
    PubMedGoogle Scholar
  • 6 Montes J, Wong J, Fayad P, Awad I. Stereotactic computed tomographic-guided aspiration and thrombolysis of intracerebral hematoma: protocol and preliminary experience.  Stroke. 2000;  31 834-840
    CrossrefPubMedGoogle Scholar
  • 7 Rohde V, Rohde I, Reinges M, Mayfrank L, Gilsbach J. Frameless stereotactically guided catheter placement and fibrinolytic therapy for spontaneous intracerebral hematomas: technical aspects and initial clinical results.  Minim Invas Neurosurg. 2000;  43 9-17
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Teernstra O, Evers S, Lodder J, Leffers P, Franke C L, Blauw G. Stereotactic treatment of intracerebral hematoma by means of a plasminogen activator. A multicenter randomized controlled trial (SICHPA).  Stroke. 2003;  34 968-974
    CrossrefPubMedGoogle Scholar
  • 9 Auer L M, Deinsberger W, Neiderkorn K, Gell G, Kleinert R, Schneider G, Holzer P, Bone G, Mokry M, Komer E, Kleinert G, Hanusch S. Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomised study.  J Neurosurg. 1989;  70 530-535
    CrossrefPubMedGoogle Scholar
  • 10 Nakano T, Ohkuma H, Ebina K, Suzuki S. Neuroendoscopic surgery for intracerebral haemorrhage. Comparison with traditional therapies.  Minim Invas Neurosurg. 2003;  46 278-283
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Nishihara T, Teraoka A, Morita A, Ueki K, Takai K, Kirino T. A transparent sheath for endoscopic surgery and its application in surgical evacuation of spontaneous intracerebral hematomas. Technical note.  J Neurosurg. 2000;  92 1053-1055
    PubMedGoogle Scholar
  • 12 Carvi y Nievas M, Pöllath A, Höllerhage H-G. Influence of preoperative clinical condition and surgical technique on the postoperative results of intracerebral hemorrhage patients. In: Böker D-K, Deinsberger W, Winking M (eds). Therapeutic Concepts in Spontaneous Intracerebral Hemorrhage. Zülpich: Bierman Verlag GmbH 1997: pp 122-126
    Google Scholar
  • 13 Kothari R, Brott T, Broderick J, Barsan W, Sauerbeck L, Zuccarello M. The ABCs of measuring intracerebral hemorrhage volume.  Stroke. 1996;  27 1304-1305
    CrossrefPubMedGoogle Scholar
  • 14 Juvela S, Heiskanen O, Poranen A, Valtonen S, Kuurne T, Kaste M, Troupp H. The treatment of spontaneous intracerebral hemorrhage: a prospective randomized trial of surgical and conservative treatment.  J Neurosurg. 1989;  70 755-758
    CrossrefPubMedGoogle Scholar
  • 15 Batjer H H, Reisch J S, Allen B C, Plaizier L J, Su C J. Failure of surgery to improve outcome in hypertensive putaminal hemorrhage: a prospective randomized trial.  Arch Neurol. 1990;  47 1103-1106
    PubMedGoogle Scholar
  • 16 Prasad K, Browman G, Srivastava A, Menon G. Surgery in primary supratentorial intracerebral hematoma: a meta-analysis of randomized trials.  Acta Neurol Scand. 1997;  95 103-110
    PubMedGoogle Scholar
  • 17 Fernandes H, Mendelow A. Spontaneous intracerebral haemorrhage: a surgical dilemma.  Br J Neurosurg. 1999;  13 389-394
    CrossrefPubMedGoogle Scholar
  • 18 Kanaya H, Kuroda K. Development in neurosurgical approaches to hypertensive intracerebral hemorrhage. In: Kaufman H (ed). Intracerebral Hematomas. New York: Raven Press Publishers 1992: pp 197-210
    Google Scholar
  • 19 Marquardt G, Wolff R, Sager A, Hartung A, Lorenz R. Manual stereotactic aspiration of spontaneous deep-seated intracerebral haematomas in non-comatose patients.  Br J Neurosurg. 2001;  15 126-131
    CrossrefPubMedGoogle Scholar
  • 20 Rabinstein A, Atkinson J, Wijdicks E. Emergency craniotomy in patients worsening due to expanded cerebral hematoma: to what purpose?.  Neurology. 2002;  58 1367-1372
    PubMedGoogle Scholar
  • 21 Kingman T A, Mendelow A, Graham D, Teasdale G. Experimental intracerebral mass: time-related effects on local cerebral blood flow.  J Neurosurg. 1987;  67 732-738
    PubMedGoogle Scholar
  • 22 Lopez Valdes E, Hernandez Lain A, Calandre L, Grau M, Cabello A, Gomez Escalonilla C. Time window for clinical effectiveness of mass evacuation in a rat balloon model mimicking an intraparenchymatous hematoma.  J Neurol Sci. 2000;  174 40-46
    CrossrefPubMedGoogle Scholar
  • 23 Nehls D, Mendelow D, Graham D, Teasdale G. Experimental intracerebral hemorrhage: early removal of a spontaneous mass lesion improves late outcome.  Neurosurgery. 1990;  27 674-682
    CrossrefPubMedGoogle Scholar
  • 24 Chambers I R, Banister K, Mendelow A. Intracranial pressure within a developing intracerebral haemorrhage.  Br J Neurosurg. 2001;  15 140-141
    CrossrefPubMedGoogle Scholar
  • 25 Nath F, Kelly P, Jenkins A, Mendelow A, Graham D, Teasdale G. Effects of experimental intracerebral hemorrhage on blood flow, capillary permeability, and histochemistry.  J Neurosurg. 1987;  66 555-562
    CrossrefPubMedGoogle Scholar
  • 26 Mendelow A. Mechanisms of ischemic brain damage with intracerebral hemorrhage.  Stroke. 1993;  24 1115-1117
    CrossrefPubMedGoogle Scholar
  • 27 Kazui S, Minematsu K, Yamamoto H, Sawada T, Yamaguchi T. Predisposing factors to enlargement of spontaneous intracerebral hematoma.  Stroke. 1997;  28 2370-2375
    PubMedGoogle Scholar
  • 28 Brott T, Broderick J, Kothari R, Barsan W, Tomsick T, Sauerbeck L, Spilker J, Duldner J, Khouri J. Early hemorrhage growth in patients with intracerebral hemorrhage.  Stroke. 1997;  28 1-5
    CrossrefPubMedGoogle Scholar
  • 29 Zazulia A R, Diringer M N, Derdeyn C P, Powers W J. Progression of mass effect after intracerebral hemorrhage.  Stroke. 1999;  30 1167-1173
    CrossrefPubMedGoogle Scholar
  • 30 Xi G, Wagner K, Keep R, Hua Y, de Courten-Myers G, Broderick P, Brott T, Hoff J. Role of blood clot formation on early edema development after experimental intracerebral hemorrhage.  Stroke. 1998;  29 2580-2586
    PubMedGoogle Scholar
  • 31 Morgenstern L, Demchuk A, Kim D, Frankowski R, Grotta J. Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage.  Neurology. 2001;  56 1294-1299
    CrossrefPubMedGoogle Scholar
  • 32 Kanaya H, Kuroda K. Development in neurosurgical approaches to hypertensive intracerebral hemorrhage. In: Kaufman H (ed), Intracerebral Hematomas. New York: Raven Press Publishers 1992: pp 197-210
    Google Scholar
  • 33 Kaneko M, Tanaka K, Shimada T, Sato K, Demura K. Long-term evaluation of ultra-early operation for hypertensive intracerebral hemorrhage in 100 cases.  J Neurosurg. 1983;  58 838-842
    PubMedGoogle Scholar

Dr. med. Mario Nazareno Carvy y Nievas

Neurochirurgische Klinik, Städtische Kliniken Frankfurt a.M.-Höchst · Akademisches Lehrkrankenhaus der Johann-Wolfgang-Goethe-Universität FFM

Goethestraße 6 - 8

65929 Frankfurt a. M.-Höchst

Germany

Phone: +49-69-3106-2243 ·

Fax: +49-69-3106-2628

Email: MCNievas@t-online.de

      >