Minimally Invasive Endoscopic Procedure for Hematoma Removal from the Human Brain

Begin with a human participant with a skull opening.

Incise the dura and pia mater to access the brain tissue cavity containing the intracerebral hematoma, a localized blood accumulation outside the vessels.

Insert a navigation probe-connected introducer sheath along the pre-determined path.

Using real-time probe guidance, the sheath reaches near the hematoma. Remove the probe and the introducer.

Now, take an endoscope connected to an irrigation system and an aspiration wand.

Insert the endoscope through the sheath. Adjust the suction and irrigation settings.

Initiate aspiration to remove the hematoma while maintaining continuous saline flow to prevent cavity collapse.

Next, reduce the suction pressure to protect the brain tissues and increase the irrigation flow to preserve the cavity's structure.

Aspirate the residual hematoma while saline flow washes the surgical field, enhancing visibility.

Once the cavity is clear, withdraw the endoscope, ensuring a minimally invasive hematoma removal.

After confirming the size and location of the injury, open the dura in a cruciate fashion and cauterize the dura leaves to within a millimeter of the bone edge. Using a number 11 blade, make a one centimeter incision in the pia mater and use bipolar cautery to cauterize the pial incision and underlying cortex.

For phase one evacuation, use a navigation stylet positioned within the introducer sheath to insert the sheath along the planned trajectory.

Remove the introducer and navigation probe once the target point is reached one to two centimeters from the distal end of the hematoma and mark the position on the skin. Now activate the preferred settings of the endoscope, including the white balance, brightness, filter, and light intensity, and attach the irrigation tubing from a two liter saline bag at shoulder height to the left working port. Set the irrigation flow rate to approximately 25% and open the right port of the endoscope to allow egress of the irrigation fluid.

Insert the endoscope into the sheath and insert the wand inside the working channel of the endoscope. Holding the wand with the dominant hand, use the pointer finger to buffer the distance between the endoscope and the wand handle to maintain a constant awareness of the location of the tip of the device within the sheath. Set the suction strength of the aspiration system to 100% and set the irrigation flow rate to low. Then aspirate any liquid hematoma that presents itself at the end of the sheath while keeping the wand within the distal one centimeter of the sheath.

When all of the hematoma has been aspirated, gently pivot the sheath laterally to explore the cavity at the same depth until no residual clot remains at that depth. Then withdraw the sheath one centimeter and repeat the aspiration until the sheath reaches the proximal wall of the cavity.

For phase two evacuation, decrease the wand suction to 25% and increase the irrigation to 100% to improve the visibility of the cavity. Explore for residual hematoma and to identify any bleeding arteries. Aspirate any remaining hematoma in a targeted fashion with low aspiration power, taking care not to damage the surrounding brain matter.

Once hemostasis is achieved, aspirate any residual hematoma along the sides or in the crevices of the cavity and confirm that the cavity is cleared of all visible hematomas and bleeding vessels.

When all of the visible hematoma has been cleared, slowly withdraw the endoscope and sheath with the endoscope at the tip of the sheath to allow examination of the dragged walls upon exiting to monitor for additional bleeding