Payoz Pandey
Calcutta National Medical College, Kolkata, India
Title: Comparison of Neuroendoscopic Evacuation vs Decompressive Craniectomy and Clot Evacuation in Management of Supratentorial Hypertensive Intracerebral Hematomas
Biography
Biography: Payoz Pandey
Abstract
Supratentorial Hypertensive hematomas are the most common form of intracerebral hematomas. Inspite of various surgical modalities to treat this problem, there is still no consensus on the definitive technique. Resource limited low middle income country setup like in India, require most optimal utilization of resources.. Aim of our study was to analyze results of surgical modalities available to us to provide a rational advice regarding treatment of Supratentorial hypertensive hemorrhages in similar setups. We have retrospectively compared results of Neuroendoscopic vs Decompressive craniectomy with clot evacuation in treatment of Supratentorial hypertensive ICH conducted at our hospital in 72 patients over past 1 year(May2018-April 2019).We utilized readily available silicone tube as tubular sheath which provided excellent visualization. In the endoscopy group M:F Ratio was 1.22:1,Average age was 52.1years,Average Pre-op hematoma volume was 42.3 cc and average GCS was 8.4 while in Craniectomy Group, M:F ratio was 1:1,Average age 51.4 years, Average Pre-op Hematoma volume was 44.5 and pre-OP GCS was 8.1. In the Neuroendoscopy group, we found statiscally significant reduction in operative time (72.65 mins vs 137mins in craniectomy), less blood loss (198.25 ml vs 704.13 ml in craniectomy group and a better Hematoma Removal ratio (87.98 vs 80.38). The Average ICU stay (6d vs 8.1 day in open) was shorter. No statistically significant reduction in Mortality or GCS improvement was found. Lesser post-operative edema was noted in the Neuro-endoscopy group. We hereby conclude that Neuro-Endoscopy for management of Supratentorial Hypertensive ICH provides a better Intra-operative visualization, reduces brain trauma, better ICH evacuation and Shorter ICU stay.