Short-term outcomes of endoscopic evacuation of supratentorial spontaneous intracerebral hematoma: Early experience from developing country.

BACKGROUND: Minimally invasive endoscopic hematoma evacuation is a promising treatment option for intracerebral hemorrhage (ICH). However, the technique still needs improvement. METHODS: We report our early clinical experience of using this technique to evacuate supratentorial spontaneous intracerebral hematomas and evaluate its short-term outcomes. RESULTS: The study included 15 patients, basal ganglia hematoma was the most common location 62.5%, mean preoperative hematoma volume was 61.07 cc, mean ICH score was 3, and mean rate of hematoma evacuation was 89.27%. Factors that could be related to mortality were Glasgow Coma Score (GCS) on admission (P = 0.001), ICH score (P = 0.004); postoperative GCS (P < 0.001), postoperative hematoma volume (P = 0.006); intraventricular extension (P = 0.001), and rate of evacuation (P = 0.001). CONCLUSION: Endoscopic technique is a safe surgical option for evacuation of spontaneous supratentorial ICH. This minimally invasive technique could be helpful to provide better short-term outcomes for selected patients. However, in our experience, this minimally invasive technique did not change the outcome for cases presented with poor GCS on admission 4/15. Our results warrant a future prospective, randomized, controlled efficacy trial.

Contrast-Enhanced Perfusion MR Imaging to Differentiate Between Recurrent/Residual Brain Neoplasms and Radiation Necrosis

Purpose: To determine the value of dynamic susceptibility contrast enhanced (DSC) MRI (magnetic resonance imaging) perfusion in the characterization of newly developed/enlarging lesions within irradiated regions after treatment of brain tumors. Methods: This prospective cross-sectional study covered 23 patients, 12 females and 11 males. All cases initially presented with histologically proven malignant brain tumors and underwent surgical intervention followed by radiotherapy (+/- chemotherapy). On follow up imaging, they presented with newly developed/progressively enhancing mass lesions at the sites of the primary tumors. All patients then underwent conventional MRI, DSC MRI perfusion and MR spectroscopy. Results: In our study, we found DSC MR perfusion to be a useful non-invasive method for differentiating recurrent brain tumors from radiation necrosis. This approach allows hemodynamic measurements to be obtained within the brain as the relative cerebral blood volume (rCBV) to complement the anatomic information obtained with conventional contrast enhanced MR imaging. The sensitivity and specificity of DSC MR perfusion for differentiation were found to be 77.8% and 80.0%, respectively. Conclusion: DSC MR perfusion is a promising technique in differentiating recurrent brain tumors from radiation necrosis as it has acceptable spatial resolution and can be routinely performed in the same settings after conventional MRI.