Dyna-CT Assisted Neuroendoscopic Hematoma Evacuation for Hypertensive Intracerebral Hemorrhage: A Novel Approach

With the increasing prevalence of hypertension due to the aging population, there is a lack of treatment and control for hypertension in middle-aged and elderly individuals in China. Chronic hypertension can lead to small degenerative changes in the perforator arteries, increasing the likelihood of perforator artery rupture and resulting in high mortality and disability rates for hypertensive intracerebral hemorrhage. Brain injury from intracerebral hemorrhage can occur through mechanical injury from the primary hematoma and secondary injury from perihematoma inflammation, leading to acute neurological deterioration and poor prognosis. Various therapeutic interventions for hypertensive intracerebral hemorrhage have been developed, with a focus on preventing hemorrhage expansion and reducing hematoma volume to reduce perihematomal edema and intracranial pressure and improve prognosis. Neuroendoscopic hematoma evacuation is a minimally invasive surgical treatment method that is considered safe, rapid, and effective, but it has limitations such as a limited visual field and narrow working canal. Intraoperative CT and Dyna-CT are effective methods for rapid assessment of residual hematoma and midline shift during minimally invasive hematoma evacuation, and Dyna-CT offers the possibility of cross-sectional imaging in the hybrid operating room for a variety of surgical procedures. Dyna-CT assisted neuroendoscopic hematoma evacuation has been found to have advantages over traditional neuroendoscopic hematoma evacuation in terms of shorter operation time, less bleeding, less damage, and clearer surgical field imaging, resulting in better functional recovery for patients with hypertensive intracerebral hemorrhage. However, there are limitations to this study, such as its retrospective nature, small sample size, and single-center design, and further evaluation through prospective, randomized controlled trials with long-term follow-up is needed.