Soft Membrane Sheath for Endoscopic Surgery of Intracerebral Hematomas

Abstract

BACKGROUND: Although the functional efficacy of surgical evacuation of an intracerebral hematoma (ICH) remains controversial, it has a valuable role for managing ICHs. Endoscopic surgery is increasingly used to evacuate ICHs; however, the narrow rigid sheath may be limiting. We report the usefulness of a soft plastic membrane sheath for endoscopic evacuation of ICHs. METHODS: The 20 x 100-mm flat membrane sheath was made of polyester film. Before introducing the sheath into the ICH cavity under navigation, one side was tucked into the opposite side to make a narrow four-layered tube. After inserting it in the brain, the tucked-in leaf was pulled out, and the slit-like tube was ready to remove the hematoma. A rigid endoscope and various instruments were introduced into the sheath. Large ICHs in the putamen and thalamus were evacuated under endoscopic visualization using the same microsurgical instruments. RESULTS: This technique was applied to 41 patients. Nearly complete evacuation of all hematomas was achieved. No surgical complication or rebleeding occurred. The new membrane sheath allowed more room for accommodating and handling the instruments, including bipolar forceps. CONCLUSIONS: This flat membrane sheath is disposable and easy to prepare, which could overcome the limitation of the instruments to allow for efficient evacuation of an ICH using the same microsurgical techniques.