Preliminary exploration of intraoperative ultrasound⁃guided endoscopic evacuation of spontaneous intracerebral hematoma

Objective To investigate the clinical value of intraoperative ultrasound and endoscopy technique on the surgery of spontaneous intracerebral hematoma. Methods A total of 17 patients who underwent ultrasound⁃guided endoscopic evacuation of spontaneous intracerebral hematoma from October 2016 to October 2019 in Department of Neurosurgery of the First Medical Center of PLA General Hospital and Hainan Hospital were selected. All hematomas were located by ultrasound during operation. At the same time, feedback the degree of hematoma clearance and calculate the hematoma removal rate. Record ultrasound and endoscopy ⁃ related complications or adverse events. Use Karnofsky Performance Status (KPS) to evaluate postoperative neurological function improvement. Results Intraoperative ultrasound and endoscopic technique were conducted in all 17 patients with a success rate of 100%, and no ultrasound and endoscopic⁃related complications or adverse events occurred. In all cases, endoscopic working sheath was once accurately introduced into the center of hematoma. Preoperative median volume of hematoma was 44.40 (31.20, 54.35) ml, and postoperative median volume was 3.00 (1.80, 5.10) ml, and the extent of hematoma removal rate was 94.01% (87.11, 96.08)%. Preoperative median KPS score was 20 (15, 30), and median KPS score was 40 (35, 50) 2 weeks after operation, which was significantly improved (Z = ⁃ 3.671, P = 0.000). Conclusions These results suggest that intraoperative ultrasound⁃guided endoscopic surgery is a safe and feasible surgical modality for spontaneous intracerebral hematoma. This combined technique may help to localize the hematoma more accurately, enhance the extent of hematoma removal, and reduce complications and facilitate neurological recovery. doi：10.3969/j.issn.1672⁃6731.2021.03.014