The intra-neuroendoscopic technique (INET): a modified minimally invasive technique for evacuation of brain parenchyma hematomas

Abstract

Background: Minimally invasive endoscopic hematoma evacuation is widely used in the treatment of intracerebral hemorrhage. However, this technique still has room for improvement. The intra-neuroendoscopic technique (INET) is a modified minimally invasive technique, and we report its safety and efficacy in evacuating brain parenchyma hematomas by comparing it with cranial puncture and drainage operation (CPDO).

Methods: The frontal, temporal, or occipital approaches were used according to the site of bleeding. The preoperative and postoperative hematoma volumes, Glasgow Coma Scale (GCS) score, Cerebral State Index (CSI), hematoma evacuation rate, operation time, complications, and 30-day mortality and Glasgow Outcome Scale (GOS) were retrospectively compared between the two groups.

Results: A total of 98 patients were enrolled. The evacuation rate (84 ± 7.1% versus 51.0 ± 8.4%, p = 0.00), 7-day GCS (11.8 ± 1.2 versus 10.4 ± 1.5, p = 0.01), and CSI (87.1 ± 8.7 versus 80.6 ± 10.2, p = 0.02) were higher, and the 30-day mortality rate (1.9% versus 15.6%, p = 0.036) was lower in the INET group. However, the operation time was longer in the INET group than in the control group (65.2 ± 12.5 min versus 45.6 ± 10.9 min, p = 0.000). Multivariable logistic regression showed that a good medium-term outcome (GOS scores 4-5) was significantly associated with INET (odds ratio (OR) 3.514, 95% confidence interval (CI) 1.463-8.440, p = 0.005), age under 65 years (OR 1.402, 95% CI, 1.041-1.888, p = 0.026), and hematoma volume less than 50 ml (OR 1.974, 95% CI 1.302-2.993, p = 0.001).

Conclusions: INET surgery for brain parenchyma hematoma evacuation is a safe and efficient modified technique. This technique is minimally invasive, has less complications, and may be helpful in providing optimal outcomes for selected patients.

Trial registration: ClinicalTrials.gov, NCT02515903. Registered on 5 August 2015.

Keywords: Brain parenchyma hematoma; Intra-neuroendoscopy technique (INET); Minimally invasive surgery; Outcome; Transparent sheath.

Conflict of interest statement

The Medical Science Ethics Committee of the Southern Medical University approved this study (NFEC-2015-034). Each patient or an appropriate family member provided informed written consent to obtain clinical materials.YesThe authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1

Transparent sheath and neuroendoscope before (a) and after (b) assembly

Fig. 2

Hematoma smashing aspirator. a Smashing device (3.0-mm diameter). b Power system. The suction can be controlled by both a gear and a pedal

Fig. 3

a Scalp incision (2.5–3.0 cm). b Bone hole (1 cm). c Endoscopic guided puncture

Fig. 4

Visible hematoma puncture with INET. a Effective avoidance of a vessel (arrow) in front during puncture. b The endoscope carefully entered the edge of the brain parenchyma hematoma (arrow). c The endoscope completely entered the center of hematoma cavity (arrow)

Fig. 5

Puncture needle was connected to a drainage tube. Arrow denotes double channels