RESUMO
Intracranial hemorrhage (ICH) in regions remote from the initial intracranial operation site is rare. The mechanism of ICH following cranial surgery remains unclear, although several theories have been proposed. Most of the reports describe cerebellar hemorrhages after supratentorial procedures or supratentorial hemorrhages after infratentorial procedures. Remote supratentorial hemorrhage (RSH) following supratentorial surgery is extremely rare. We report a case of postoperative RSH occurring away from the surgical site. A 62-year-old woman underwent a right occipital lobectomy to resect lung carcinoma metastases. The patient developed a postoperative consciousness disturbance, and a brain computed tomography (CT) scan revealed an ICH in the left frontal region. The patient underwent ICH evacuation, but remained severely disabled. It is necessary to be aware that this complication is possible after craniotomy.
RESUMO
Ultra-early surgical treatment in which associated brain injury is minimized and maximal volume of hematoma is removed shortly after onset with secure hemostasis is expected to be established. We developed a transparent guiding sheath and other surgical instruments for endoscopic surgery and established a novel, ultra-early stage surgical procedure using those instruments. This procedure has the following characteristics: (a) burr hole opening under local anesthesia is possible; (b) a transparent sheath improves the visualization of the surgical field in the parenchyma and the hematoma; (c) free-hand surgery without fixing an endoscope and a sheath to a frame facilitates three-dimensional operation; (d) secure hemostasis by electric coagulation is possible; (e) relatively simple surgical instruments are easy to prepare. We have performed this procedure in 82 patients with intracerebral or intraventricular hemorrhage (44 with putaminal hemorrhage, 12 with thalamic hemorrhage, 8 with subcortical hemorrhage, 8 with cerebellar hemorrhage, 10 with intraventricular hemorrhage). Twenty-four of those patients received our treatment in the ultra-early stage (within 3 hours after onset). The mean duration of surgery was 63 minutes, the mean hematoma reduction rate was 96%, and no peri-operative hemorrhage with deterioration of symptoms and/or signs occurred. Therefore, we believe that endoscopic hematoma evacuation with our surgical procedure is a promising ultra-early stage treatment for intracerebral hemorrhage and that it may improve the long-term prognosis in patents with intracerebral hemorrhage.
