J Korean Neurosurg Soc.  2022 Nov;65(6):846-852. 10.3340/jkns.2021.0248.

Supraorbital Endoscopic Evacuation for Traumatic Intracerebral Hematomas in the Frontal Lobe

• Oh HJ
• Hwang SC

• KMID: 2535845
• DOI: http://doi.org/10.3340/jkns.2021.0248

Abstract

Objective
: Traumatic intracranial hematomas have been rarely evacuated by endoscopic surgery. The frontal lobe is the usual location for the traumatic intracerebral hematoma (TICH). Endoscopic evacuation for the frontal TICHs via an eyebrow incision is to be presented as minimally invasive surgery.
Methods
: Thirteen patients with frontal TICHs were managed with endoscopic hematoma evacuation via eyebrow incision. After making the incision in the lateral eyebrow, a small frontal craniotomy was made, and the hematoma was evacuated under direct visualization of a rigid endoscope. No catheter was placed. Orbital rim resection, hematoma evacuation rate, surgical complications, and outcome at discharge were analyzed.
Results
: Men were 11 and the mean age was 54 years old (range, 27–86). Orbitotomy was performed in four patients, and no effect on the hematoma evacuation rate was observed. More than 80% of the hematoma volume was successfully removed in 10 cases. Hematoma configuration was not related to the hematoma evacuation rate. None of the patients underwent revision operation or decompressive craniectomy.
Conclusion
: Endoscopic evacuation of the TICHs with the supraorbital approach may be a good method to evacuate the hematoma located in the frontal base.

Keyword

Craniotomy; Endoscopy; Frontal lobe; Traumatic cerebral hemorrhage

Figure

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  Fig. 1. Illustrations of case 1. A : Computed tomography (CT) scan of a semicomatose conscious 46-year-old man taken immediately after the motorcycle accident. A large amount of epidural hematoma (EDH) in the right parietal and intracerebral hematoma (ICH) in the left frontal lobe can be seen. B : Postoperative CT scan after craniotomy and evacuation of EDH on the right parietal. Frontal ICH slightly grows and compresses the lateral ventricle. Supraorbital endoscopic evacuation of frontal ICH was attempted and ICH was sufficiently removed (C). Small craniotomy on the left supraorbital skull (arrow) was visualized (D).

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  Fig. 2. Illustrations of case 2. A 74-year-old man was found with semicomatose consciousness. Huge intracerebral hematoma (ICH) in the right frontal lobe can be seen (A). After endoscopic evacuation for ICH, nearly total removal was achieved (B). Endoscopic views of the cortical incision (C) and final stage with hemostasis (D).

Reference

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