Article Text

other Versions

Case series
The Stereotactic Intracerebral Hemorrhage Underwater Blood Aspiration (SCUBA) technique for minimally invasive endoscopic intracerebral hemorrhage evacuation
  1. Christopher Paul Kellner,
  2. Alexander G Chartrain,
  3. Dominic A Nistal,
  4. Jacopo Scaggiante,
  5. Danny Hom,
  6. Saadi Ghatan,
  7. Joshua B Bederson,
  8. J Mocco
  1. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  1. Correspondence to Dr. Christopher Paul Kellner, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City New York USA ; christopher.kellner{at}


Background Endoscopic intracerebral hemorrhage (ICH) evacuation techniques have gained interest as a potential therapeutic option. However, the instrumentation and techniques employed are still being refined to optimize hemostasis and evacuation efficiency.

Objective We describe the application of a specific endoscopic technique in the treatment of ICH called the Stereotactic Intracerebral Hemorrhage Underwater Blood Aspiration (SCUBA) technique. It differs from previously described minimally invasive ICH interventions in that it combines two separate neuroendoscopic strategies in two phases, the first under dry-field conditions and the second using a wet-field strategy.

Methods All patients who underwent endoscopic ICH evacuation with the SCUBA technique from December 2015 to September 2017 were included.

Results The SCUBA technique was performed in 47 patients. The average evacuation percentage was 88.2% (SD 20.8). Active bleeding identified to derive from a specific source was observed in 23 (48.9%) cases. Active bleeding was addressed with irrigation alone in five cases (10.6%) and required electrocautery in 18 cases (38.3%). Intraoperative bleeding occurred in 3 patients (6.4%) and postoperative bleeding occurred in a single case (2.1%).

Conclusions The SCUBA technique provides surgeons with a defined strategy for true endoscopic hematoma evacuation. In particular, the fluid-filled cavity in SCUBA Phase 2 has the potential to provide several advantages over the traditional air-filled strategy, including clear identification and cauterization of bleeding vessels and visualization of residual clot burden. Further investigation is necessary to compare this technique to others that are currently used.

  • hemorrhage
  • endoscopy
  • navigation

Statistics from


  • CPK and AGC contributed equally.

  • Contributors All authors contributed to the manuscript through data collection, analysis, manuscript composition, and critical review. All authors provided final approval for publication.

  • Funding This research was supported in part by a grant from Arminio and Lucyna Fraga and by a grant from Mr. and Mrs. Durkovic.

  • Competing interests JM receives research grant support from Penumbra, Inc.

  • Patient consent Obtained.

  • Ethics approval Mount Sinai IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.