Transtubular Evacuation of Hypertensive Intracerebral Hemorrhage with Limited Equipment

Hypertensive intracerebral hemorrhage is common in developing countries, where many patients with hypertension are not detected and well treated. The tubular retractor system provides the opportunity for surgeons to evacuate the clot and achieve hemostasis under direct vision. We showed a transtubular surgery performed in a developing country with limited equipment (Video 1). A 62-year-old man with a right-side basal ganglia hematoma was admitted. Head computed tomography showed the volume of the hematoma was 49.67 mL, and the Glasgow Coma Scale was 7 when admitting. After getting written consent from the patient's family, a transtubular evacuation of intracerebral hemorrhage was performed with headlight and surgical loupes. Left-side external ventricular drain was done first. A surgical tube was inserted through the right middle frontal gyrus to the base of the hematoma, gentle suction was applied to remove the clot, and hemostasis was achieved by bipolar coagulation and compression. Postoperative computed tomography scan confirmed a near total removal of the hematoma, with a clearance rate of 93.6%. The patient's postoperative Glasgow Coma Scale score was 12, and left upper and lower extremity movement improved to grade 4. The patient was discharged 10 days postoperatively with no further complications. This minimally invasive transtubular approach provides a new option for reducing the mass effect of the hematoma without aggressive manipulation of the normal brain tissue. We showed our experience of performing the surgery with limited equipment. This technique could be used in more rural areas to help local patients there.