Fully endoscopic freehand evacuation of spontaneous supratentorial intraparenchymal hemorrhage

OBJECTIVE: A modification of other reported endoscopic Intracerberal clot evacuation is reported. METHODS: From January 2014 to December 2014 we operated on 6 patients harboring a spontaneous supratentorial intracerebral hemorrhage (ICH) using a fully endoscopic free hand technique. The surgical technique is described and illustrated. Clinical chart and surgical videos were analyzed. Volumetric evaluation of the clot preoperatively and the residual hematoma post-operatively was performed. Clinical outcome was measured by means of mRS and GOS. RESULTS: The mean operative time was 96 min (range 72-125). Clot evacuation was > 90% in all patients. No patient re-bled after surgery. Two patients died. The 6 months GOS was 4 in two patients, 3 in 2 patients and 1 (death) in two patients. According to mRS the 6 months outcome was 6 (death) in two patients, 4 in two patients, 3 in one patient and 2 in one patient. CONCLUSIONS: The proposed technique allows good rate of hematoma evacuation and intraoperative bleeding control using a minimally invasive technique. Further studies on large series should confirm the role of this free hands endoscopic technique.