case_images: PMC10766349_01
case_images: Case of a thalamic hemorrhage with extension to the brainstem. (A) An initial CT scan performed in the emergency room showed thalamic hemorrhage with extension to the brainstem and displayed a hematoma from the midbrain to the thalamus. (B) On the first day after the surgery, another CT showed that most of the hematoma had been removed. (C) Seven days later, a magnetic resonance imaging (MRI) scan was performed, which showed that a part of the white fiber had been saved, as shown by DTI.
case_images: fsurg-10-1277990-g001.jpg
case_images: PMC10766349_01_fsurg-10-1277990-g001.jpg
case_images: F1
case_images: A computed tomography (CT) scan showed TH with hematoma extension into the brainstem (Figure 1A). One day after the surgery, a CT scan showed that the hemorrhaging had stopped and most of the hematoma had been removed (Figure 1B). Seven days later, a diffusion tensor imaging (DTI) scan showed that some of the white matter structure had been preserved (Figure 1C).
case_images: The vision from an endoscope in this case. (A) During the operation, the patient was placed in the left lateral oblique position with her upper body elevated by 30 . (B) The endoscope was used to access the supracerebellar infratentorial region, and we identified a single bridge vein, which we coagulated with bipolar cautery. (C) Gallen vessels and Rosenthal's veins. (D) The dorsal part of the pons was also identified, which allowed us to quickly locate and remove the hemorrhage; the blue arrow points to the area of the hematoma. (E) We used the endoscope to follow the hemorrhage and removed approximately 40 ml of blood.
case_images: fsurg-10-1277990-g002.jpg
case_images: PMC10766349_01_fsurg-10-1277990-g002.jpg
case_images: F2
case_images: During the surgery, the patient was positioned in the left lateral oblique position with her upper body elevated by 30  (Figure 2A). Using the endoscope, we accessed the supracerebellar infratentorial region and identified a single bridge vein, which we coagulated using a bipolar cautery (Figure 2B). We then located the vein of Galen (Figure 2C) and Rosenthal's veins, behind which we found the hemorrhage. The dorsal part of the pons was also identified, enabling us to quickly locate and remove the hemorrhage (Figure 2D). Approximately 40 ml of blood was removed in the process of following the hemorrhage using the endoscope (Figure 2E).