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the stereotactic intracerebral hemorrhage underwater blood aspiration (scuba) technique for minimally invasive endoscopic intracerebral hemorrhage evacuation

by:Qihao      2019-08-31
Endoscopic cerebral hemorrhage (ICH)
Evacuation technology has attracted interest as a potential treatment option.
However, in order to optimize the efficiency of stopping bleeding and evacuation, the instruments and techniques used are still being improved.
Objective we describe the application of a special endoscopic technique in the treatment of ICH, called the underwater blood aspiration for stereo-directional cerebral hemorrhage (SCUBA)technique.
It is different from the previously described minimally invasive ICH intervention because it combines two independent Neuroendoscopic strategies in two stages, the first being in a dry state
On-site conditions and wet use-field strategy.
Methods all patients who used scuba diving techniques for endoscopic ICH evacuation from December 2015 to September 2017 were included.
Results The scuba diving technique was used in 47 patients.
The average evacuation percentage was 88. 2% (SD 20. 8).
Active bleeding found from specific sources was observed for 23 years (48. 9%)cases.
Five cases of active bleeding were solved by irrigation alone (10. 6%)
And requires 18 cases (38. 3%).
Bleeding occurred in 3 patients (6. 4%)
Single case of postoperative bleeding (2. 1%).
Conclusion scuba technique provides a clear and real strategy for the removal of hematoma under endoscope for surgeons.
Especially fluid-
The filling cavity of the second stage of the scuba is likely to provide more air than traditional air-
Filling strategies, including clear identification and burning of bleeding vessels and visualization of residual blood clot load.
In order to compare this technology with other technologies currently in use, further research is necessary.
Background endoscopic cerebral hemorrhage (ICH)
Evacuation technology has attracted interest as a potential treatment option.
However, in order to optimize the efficiency of stopping bleeding and evacuation, the instruments and techniques used are still being improved.
Objective we describe the application of a special endoscopic technique in the treatment of ICH, called the underwater blood aspiration for stereo-directional cerebral hemorrhage (SCUBA)technique.
It is different from the previously described minimally invasive ICH intervention because it combines two independent Neuroendoscopic strategies in two stages, the first being in a dry state
On-site conditions and wet use-field strategy.
Methods all patients who used scuba diving techniques for endoscopic ICH evacuation from December 2015 to September 2017 were included.
Results The scuba diving technique was used in 47 patients.
The average evacuation percentage was 88. 2% (SD 20. 8).
Active bleeding found from specific sources was observed for 23 years (48. 9%)cases.
Five cases of active bleeding were solved by irrigation alone (10. 6%)
And requires 18 cases (38. 3%).
Bleeding occurred in 3 patients (6. 4%)
Single case of postoperative bleeding (2. 1%).
Conclusion scuba technique provides a clear and real strategy for the removal of hematoma under endoscope for surgeons.
Especially fluid-
The filling cavity of the second stage of the scuba is likely to provide more air than traditional air-
Filling strategies, including clear identification and burning of bleeding vessels and visualization of residual blood clot load.
In order to compare this technology with other technologies currently in use, further research is necessary.
Spontaneous ICH is a devastating stroke with a death rate of more than 40%.
1 2 trials investigating the benefits of open bone flap and withdrawal showed no significant difference in functional outcomes between surgery and medical treatment groups.
However, some recent trials aimed at avoiding invasive shortcomings in open bone surgery trials using minimally invasive strategies such as mistie ii and ICES have produced promising findings.
5-7 despite these efforts, current minimally invasive techniques do not allow for a clear display of residual blood clot burden, and reliable visualization and burning of active arterial bleeding.
Here we propose a new Neuroendoscope technique called stereo directional ICH underwater blood aspiration (SCUBA)
, Designed to solve these shortcomings by using fluidfilled cavity.
Methods from December 2015 to September 2017, all patients who used scuba diving techniques for endoscopic ICH evacuation were included in this retrospective case series.
Indications and patient qualification criteria used include the following: Volume of hematoma> 20 cc, volume stability of hematoma with 2 CT scans at intervals of 6 hours, stroke scale of the National Institutes of Health (NIHSS)
Glasgow Coma Score ≥ 6 (GCS)
≥ 4 points, modified Rankin score at baseline (mRS) 20 cc, volume stability of hematoma with 2 CT scans at intervals of 6 hours, stroke scale of the National Institutes of Health (NIHSS)
Glasgow Coma Score ≥ 6 (GCS)
≥ 4 points, modified Rankin score at baseline (mRS) 90% evacuation in the axial position (E)and coronal (F)planes.
The first phase of the scuba is shown in the accompanying video, showing the desire to dry at the end of the sheath
Site conditions (video 1).
It continues to observe brain closure around the end of the sheath, lateral maneuver of the sheath to explore the side wall of the cavity, and incremental contraction of the sheath (video 2).
By retracting the suction device with the endoscope, a large piece of condensed blood was found and taken out (video 3).
In the second stage of the scuba, a double clot is drawn from the cavity wall with a gentle suction (video 4).
Active bleeding was treated with continuous flushing and bipolar burning (video 5). Post-
Evacuation ultrasound (figure 5C–D)
And CT during Operation (figure 5E–F)
Confirmed evacuation of 90% people
After the operation, CT showed
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