Safety and efficacy of 3D navigation-guided endoscopy for intracranial hemorrhage in patients with early cerebral hernia

Background: In cases of intracerebral hemorrhage (ICH) accompanied by cerebral hernia, timely intervention is of paramount importance due to the rapid progression of the condition. Currently, craniotomy is the prevailing clinical procedure employed in such circumstances. Nevertheless, endoscopic techniques have exhibited numerous advantages in managing ICH. This study aimed to assess the effectiveness and feasibility of 3D navigation-guided endoscopy for ICH patients presenting early clinical manifestations of cerebral hernia. Methods: We conducted a retrospective analysis of 11 ICH patients with cerebral hernia who underwent neuroendoscopic hematoma evacuation guided by 3D navigation technology at the Department of Neurosurgery in Dalang Hospital between January 2019 and January 2022. By utilizing 3D reconstructed CT scanning technology, our research team successfully created patient-specific brain and hematoma models. This enabled precise preoperative planning of puncture positioning, angle, depth, and needle direction. We conducted short-term and long-term neurological function evaluations on postoperative patients to assess their neurological recovery following surgery. Results: The improvement in postoperative and discharge Glasgow Coma Scale score provides compelling evidence for the effectiveness of the surgical intervention and indicates a positive short-term prognosis. At the 6-month follow-up assessment, the observed mortality rate was 9.09 %. Importantly, all surviving patients demonstrated a favorable recovery of neurological function, as indicated by the modified Rankin Scale and Glasgow Outcome Scale scores. Conclusion: These findings support the hypothesis to some extent that 3D navigation-guided endoscopic evacuation may enhance the functional prognosis of ICH patients with early clinical manifestations of cerebral hernia.