Endovascular Treatments for Brain Aack Introduction - Microsurgery: Advances, Simulations, and Applications - page 65

2.4 Intracerebral Brain Hemorrhage

The principal cause of intracerebral hemorrhage is hypertension
(especially uncontrolled hypertension) followed by cerebral amyloid
angiopathy. The place with more frequent occurrence is the putamen
followed by the thalamus, sub-cortex, cerebellar dentate nucleus
and pons. It is thought that a cause of intracerebral hemorrhage
in patients with hypertension is the ruptured micro-aneurysm
that appears as a consequence of the swelling up of cerebral blood
vessels affected by ibrinoid necrosis [49, 50]. Large hematoma has
low survival rate due to early bleeding. Conventionally emergency
surgery to remove hematoma was carried out under the microscope.
In the recent years, endoscopic systems have been used. For that, an
incision of about 5 cm is done in the skin and a bar hole is opened
to the skull (Fig. 2.20a), within a transparent sheath (Fig. 2.19a) an

Figure 2.19 Schematic explaining the endoscopic system and treatment
[51]. (a) Transparent sheath used as trocar for the endoscope
and aspiration tube. (b) Inner cylinder, inserted within the
transparent sheath for guiding the sheath insertion into the
hematoma. (c) Aspiration tube, bent in its middle body for
facilitating the endoscopic surgery. (d) Rigid endoscope with
the light source and lens attached. (e) Schematic for treatment
explanation: The sheath is inserted into the hematoma for
extracting the hematoma. The endoscope is used for inspection
within the hematoma.