Use of flexible endoscopic aspiration for an intraventricular small floating clot with hemorrhage: a technical note
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TECHNICAL NOTE
Use of flexible endoscopic aspiration for an intraventricular small floating clot with hemorrhage: a technical note Hiroaki Neki 1,2 & Aoto Shibata 1 & Hiroyuki Komine 1 & Shinya Kohyama 2 & Fumitaka Yamane 3 & Shoichiro Ishihara 4 & Yuichiro Kikkawa 1 Received: 25 May 2020 / Revised: 9 September 2020 / Accepted: 15 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Although flexible endoscopy is effective for intraventricular lesions, it is less frequently used for hemorrhagic cases. In some hemorrhagic strokes, blood clots may plunge into the cerebral aqueduct and cause acute obstructive hydrocephalus. A flexible endoscope can aspirate clots and prevent acute hydrocephalus. Methods Here, we report four cases of hemorrhage: one of intracerebral hemorrhage and three of subarachnoid hemorrhages. Results In all cases, acute hydrocephalus was not apparent upon admission. Sudden comatose occurred; computed tomography revealed acute obstructive hydrocephalus with a strangulated clot in the cerebral aqueduct. We performed aspiration of the strangulated clot using a flexible endoscope. Consciousness improved in all cases, and acute hydrocephalus was prevented in all cases. Conclusion The use of simple flexible endoscopic aspiration for clots might be a beneficial and less-invasive procedure for acute obstructive hydrocephalus caused by a small clot with hemorrhagic stroke. Keywords Flexible endoscopy, Cerebral aqueduct, Acute hydrocephalus, Clot, Aspiration
Introduction Neuroendoscopic procedures have been developed over several decades. In particular, flexible neuroendoscopy is employed in patients with intraventricular lesions in hemorrhagic disease as well as in tumors [2, 7, 8, 14, 21, 22]. Intraventricular hemorrhage with stroke disrupts the cerebrospinal fluid (CSF) [1] circulation and results in to acute obstructive hydrocephalus. Neuroendoscopic aspiration provides a minimally invasive and safe means to remove hematoma and results in static CSF circulation [1, 12]. Small * Hiroaki Neki [email protected] 1
Department of Neurosurgery, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan
2
Department of Endovascular Neurosurgery, International Medical center Saitama Medical University, Hidaka, Saitama, Japan
3
Department of Neurosurgery, Teikyo University School of Medicine, Itabashi, Tokyo, Japan
4
Department of Neurosurgery, Saitama Sekishinkai Hospital, Sayama, Saitama, Japan
floating clots may infrequently plunge into the cerebral aqueduct and result in obstructive hydrocephalus [6]. CSF drainage is usually proposed in rare, urgent clinical situations [9, 20], and few cases involving neuroendoscopic aspiration for stuck floating clots have been reported [5, 13]. Here, we treated four cases by performing flexible endoscopic aspiration for stuck floating clots and described the pitfalls of this procedure.
Methods Case series Small floating clots were aspirated using a flexible neuroendoscope in four cases. Table 1 show
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