Authors’ Modification of Transparent Trocars for Endoscope-Assisted Evacuation of Intracerebral Hematomas

Introduction: Intracerebral hematomas (ICH) are socially significant disease with consequent high mortality or severe disability. Surgical treatment of ICH is still subject of controversy regarding the indications, timing and methodology. Aim: To evaluate the usefulness of the modified by the authors transparent trocars for endoscope-assisted ICH evacuation in different brain locations. Material and Methods: The study was conducted with clearly defined criteria based on thorough analysis of the literature. Endoscope-assisted evacuation of 41 patients with ICH was performed with a modification of the authors of transparent trocars with dimensions: length- 80 mm, width- 11 mm and beveled tip with angle of 45 degrees. The applied instruments were also modified according to the system to perform identical procedures and techniques of suction and hemostasis. The degree of ICH evacuation was evaluated by comparing the pre- and postoperative CT scans. Results: Timing of the procedure was within 72 hours of clinical onset. The percentage of ICH evacuation differed significantly: 95% in the subcortical group, 90% in the putaminal group, 35% in the thalamic group and 75% in the cerebellar group. The modified transparent trocars allowed clear orientation for the limits of the hematoma and visualization of its border with the neighboring edematous brain parenchyma. The beveled trocar tip supplied wider working space in the required direction and propagation of ICH to the visible area. The mean operative time was 60 minutes. Conclusion: The modified transparent trocars supply wider working space in the hematoma direction and propagation of ICH to the visible area. Thus, it represents reasonable tool for achieving higher efficacy of endoscope-assisted evacuation of ICH.