Surgical options of hypertensive intracerebral hematoma: stereotactic endoscopic removal versus stereotactic catheter drainage.

The authors analyzed the difference between two surgical procedures, stereotactic endoscopic removal (SER) and stereotactic catheter drainage (SCD), in 18 patients of ganglionic intracerebral hematoma (ICH). Ten patients underwent SCD and eight SER within 24 hours of insult. The mean age was 53.3 (33-81) years and male to female ratio was 11:7. The mean volume of hematoma was 34.4 (23-105) ml. All patients had major neurological deficits without signs of transtentorial herniation. Mean follow-up was 8 (6-10) months. Under local anesthesia, Otzuki's cannula was placed through a burr hole. ICH was removed with suction and forceps under endoscopic guidance. Hemostasis was performed with Nd-YAG laser. For SCD, we used silicone catheter and urokinase. The hematoma was drained in 3-5 days in SER, whereas 7-10 days in SCD. Postoperative rebleeding occurred in one case of SER. Mortality rate was 13% in SER, 10% in SCD. The patients who gained most from these treatments were those who had been admitted with an impaired level of consciousness. The whole procedure can be done under direct vision in SER, so SER might replace SCD with similar mortality.