Effect analysis of neuroendoscopy surgery for ventricular casting

Abstract

Objective To summarize the technical points and curative effects of neuroendoscopy in the removal of ventricular casting hematoma. Methods A total of 36 patients with ventricular casting who underwent neuroendoscopy hematoma evacuation in Huaihe Hospital of He'nan University from January 2019 to May 2021 were included. Among them, 12 cases were whole ventricle casting, 15 cases were third ventricle and unilateral lateral ventricle casting, and 9 cases were the third ventricle and bilateral lateral ventricle casting. A small arc⁃shaped incision was made parallel to the sagittal suture in the case of heavy whole ventricle casting, which made the incision anterior 2/3 and posterior 1/3 of the coronal suture. Compared with the conventional frontal angle puncture incision, the incision was moved back by 1-2 cm. A 10ml syringe was used to create a self⁃made endoscope working channel, precise positioning to avoid damage to brain tissue due to continuous changes in the direction and depth of the sleeve. At 3 months after surgery, the quality of daily life and prognosis of the patients were evaluated according to the Activities of Daily Living Scale (ADL) and Glasgow Outcome Scale (GOS). Results The average surgery time was 1.50 h. The hematoma clearance rate was＞90% in 32 cases and＞80%-90% in 4 cases. CT showed no residual hematoma, and the ventricular system returned to normal anatomical shape. Continuous lumbar drainage after surgery was undergone in 28 cases, while lumbar puncture and drainage was undergone in 8 cases. On the 14th day after surgery, the GCS score was 11.63±2.47, which was higher than the preoperative score of 9.82±1.68 (t=3.162, P=0.021), with significant improvement in eye opening and motor function. There were no deaths during hospitalization, and 2 patients died of pulmonary infection at 3 months after the surgery. Among the survival patients, 94.12% (32/34, 18 cases of ADL grade Ⅱ and 14 cases of grade Ⅲ, or 18 cases of GOS score 5 and 14 cases of GOS score 4) had good quality of life, 5.88% (2/34, ADL grade Ⅳ or GOS score 3) were not good. Conclusions Under the direct vision of neuroendoscopy, the ventricular casting hematoma can be quickly removed, which relieved the pressure of the ventricle, shorten the recovery period of patients, and improved the quality of life after surgery. It is worthy of clinical application.

doi：10.3969/j.issn.1672⁃6731.2022.10.006