Balanced irrigation-suction technique with a multifunctional suction cannula and its application for intraoperative hemorrhage in endoscopic evacuation of intracerebral hematomas: technical note.

OBJECTIVE: Endoscopic evacuation of intraoperative hemorrhage is proving to be increasingly useful and effective. For general agreement that endoscopic evacuation has advantages over craniotomy, secure hemostatic procedures are crucial. TECHNIQUE: This technical note focuses on hemostatic procedures for managing intraoperative hemorrhage. Handling of the multifunctional suction cannula and its application for balanced irrigation-suction are fully explained in this report. RESULTS: Nearly complete evacuation of hematoma was achieved in all 15 cases. In 9 cases of intraoperative arterial bleeding, secure hemostatis has been accomplished. No surgical complications or rebleeding occurred. CONCLUSION: Even careful atraumatic evacuation of a hematoma can sometimes result in intraoperative hemorrhage. Repeated irrigation and point suctioning may be necessary to keep the operating field clear. A multifunctional suction cannula would be useful for maintaining irrigation and suction balance. Coagulation of a bleeding artery can be performed under clear visualization. A balanced irrigation-suction technique results in secure hemostasis.