Image-guided endoscopic surgery for spontaneous supratentorial intracerebral hematoma
| Autor: | Guochen Sun, Xiao-Dong Ma, Gang Liu, Xinguang Yu, Lei Liu, Ding-Biao Zhou, Ru-yuan Zhu, Bainan Xu, Yuan-zheng Hou, Xiaolei Chen, Hao Tang, Jiashu Zhang |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Suction (medicine) medicine.medical_specialty Endoscope Endoscopic surgery Surgical planning 03 medical and health sciences 0302 clinical medicine Hematoma Humans Medicine 030212 general & internal medicine Aged Cerebral Hemorrhage Aged 80 and over medicine.diagnostic_test business.industry General Medicine Middle Aged medicine.disease Intracerebral hematoma Surgery Endoscopy Surgery Computer-Assisted Neuroendoscopy Female Augmented reality business Vascular Surgical Procedures 030217 neurology & neurosurgery |
| Zdroj: | Journal of Neurosurgery. 127:537-542 |
| ISSN: | 1933-0693 0022-3085 |
| DOI: | 10.3171/2016.7.jns16932 |
| Popis: | OBJECTIVEEndoscopic removal of intracerebral hematomas is becoming increasingly common, but there is no standard technique. The authors explored the use of a simple image-guided endoscopic method for removal of spontaneous supratentorial hematomas.METHODSVirtual reality technology based on a hospital picture archiving and communications systems (PACS) was used in 3D hematoma visualization and surgical planning. Augmented reality based on an Android smartphone app, Sina neurosurgical assist, allowed a projection of the hematoma to be seen on the patient's scalp to facilitate selection of the best trajectory to the center of the hematoma. A obturator and transparent sheath were used to establish a working channel, and an endoscope and a metal suction apparatus were used to remove the hematoma.RESULTSA total of 25 patients were included in the study, including 18 with putamen hemorrhages and 7 with lobar cerebral hemorrhages. Virtual reality combined with augmented reality helped in achieving the desired position with the obturator and sheath. The median time from the initial surgical incision to completion of closure was 50 minutes (range 40–70 minutes). The actual endoscopic operating time was 30 (range 15–50) minutes. The median blood loss was 80 (range 40–150) ml. No patient experienced postoperative rebleeding. The average hematoma evacuation rate was 97%. The mean (± SD) preoperative Glasgow Coma Scale (GCS) score was 6.7 ± 3.2; 1 week after hematoma evacuation the mean GCS score had improved to 11.9 ± 3.1 (p < 0.01).CONCLUSIONSVirtual reality using hospital PACS and augmented reality with a smartphone app helped precisely localize hematomas and plan the appropriate endoscopic approach. A transparent sheath helped establish a surgical channel, and an endoscope enabled observation of the hematoma's location to achieve satisfactory hematoma removal. |
| Databáze: | OpenAIRE |
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