New approach of stereotactic aspiration combine with neuroendoscopy and decompressive craniectomy for spontaneous supratentorial intracerebral hemorrhage with tentorial herniation

Abstract Objective To introduce a new “three-in-one technique” surgical approach of "stereotactic aspiration + neuroendoscopy + decompressive craniectomy” for spontaneous supratentorial intracerebral hemorrhage (SSICH) with tentorial herniation patients and to explore its preliminary application. Methods On our previous “two-in-one technique” operation, we further combined decompressive craniectomy to form a special surgical approach for SSICH with tentorial herniation patients. The operation included three steps: 1. Burr hole and aspirate partially clot to rapidly decrease intracranial pressure (ICP); 2. Remove the residual hematoma and stop the bleeding under neuroendoscope; 3. Decompressive craniectomy for further complete decompression. Clinical data of 17 patients with SSICH and cerebral hernia who underwent this approach in our department from January 2019 to February 2022 were collected, and time to access hematoma, hematoma evacuate rate and the outcome were analyzed. Results All procedures were successfully completed and the average access time to hematoma was 4.8 minutes in “three-in-one technique” group, which was much less than in craniotomy group (36.3 minutes) and neuroendoscopy group (9.9 minutes). Among the 17 patients, 3 died, 7 give up, 5 improved and 2 clinical cured. The poor prognosis (Death + Give up ) was 58.8% which was much better than traditional craniotomy group in previously published studies. Conclusions This “three-in-one technique” surgical approach combines the advantages of rapid decompression by stereotactic aspiration, full decompression and minimizing iatrogenic brain injury by neuroendoscope, complete decompression by decompressive craniectomy, which is a beneficial attempt for SSICH with tentorial herniation patients.