WILLPOWER MELTDOWN SOMETIMES

An 81-year-old woman developed a cerebral hemorrhage in the left anterior and temporal lobe. The following day after admission, her level of consciousness and right hemiparesis worsened. I decided to perform endoscopic hematoma aspiration under local anesthesia. The hematoma was extremely hard, so partial removal was attempted. However, bleeding occurred when attempting to remove the hard portion, necessitating discontinuation. To reduce intracranial pressure, the liquefied portion was removed enough. Postoperative CT showed improvement in midline shift, but 80% of the solid hematoma remained. A colleague noted, “For removing the surface hematoma, a small craniotomy is more suitable than an endoscopic approach.” I have a different idea. I am thinking how to remove surface hematoma by endoscopy. On postoperative day 1, the symptoms such as aphasia and right-sided neglect remained but was a little better than yesterday.