Vernon L Velho

Title: A minimally invasive endoscopic surgery for intracranial hypertensive hemorrhagic stroke

Abstract

Background:

Intracranial hypertensive hemorrhagic stroke remains a major cause of mortality and long-term disability due to mass effect and raised intracranial pressure (ICP). Traditional open craniotomy, while effective for hematoma evacuation, is associated with significant surgical morbidity. Minimally invasive endoscopic evacuation has emerged as a less disruptive alternative aimed at reducing secondary brain injury while achieving adequate decompression.

Methods:

This prospective study was conducted over a two-year period and included 100 patients with intracranial hypertensive hemorrhagic stroke presenting with significant hematoma volume and raised ICP. All patients underwent minimally invasive endoscopic hematoma evacuation using a standardized technique through a small craniostomy. Clinical and radiological parameters were analyzed, including hematoma evacuation rate, postoperative ICP control, neurological improvement, complications, and functional outcome at follow-up.

Results:

Complete or near-complete hematoma evacuation (>70%) was achieved in 85% of patients. Early postoperative neurological improvement and effective control of raised ICP were observed in 78 patients. Radiological decompression correlated well with clinical recovery. At follow-up, 72% of patients demonstrated favorable functional outcomes. Procedure-related morbidity was low; complications included limited rebleeding in 4 patients and transient cerebral edema in 6 patients, all managed successfully. The overall mortality rate was 8%, comparing favorably with reported outcomes of conventional open surgery.

Conclusion:

Minimally invasive endoscopic surgery is a safe and effective approach for intracranial hypertensive hemorrhagic stroke. It provides efficient hematoma evacuation, rapid ICP control, and encouraging functional outcomes with reduced surgical trauma. This technique represents a valuable advancement in the surgical armamentarium for hemorrhagic stroke and warrants wider consideration in appropriately selected patients.

What will the audience take away from your presentation? 

1.  Minimally invasive endoscopic evacuation is an effective treatment for selected hypertensive hemorrhagic strokes
   
   The technique achieves substantial hematoma reduction and rapid control of raised intracranial pressure, translating into meaningful neurological improvement and favorable functional outcomes in a majority of patients.


2.  Lower morbidity and mortality compared with traditional open surgery
   
   The endoscopic approach minimizes surgical trauma and secondary brain injury, resulting in fewer complications and a mortality rate that compares favorably with historical outcomes of conventional craniotomy—an important consideration for acute stroke management.


3.  Early surgical intervention can positively influence long-term neurological recovery
   
   Prompt, targeted hematoma evacuation using minimally invasive methods may improve neurological stabilization and functional recovery, reinforcing the importance of timely neurology–neurosurgery collaboration in managing intracranial hypertensive hemorrhagic stroke.