Mohamed A Labib1, Mitesh Shah2, Amin B Kassam3, Ronald Young2, Lloyd Zucker4, Anthony Maioriello5, Gavin Britz6, Charles Agbi7, J D Day8, Gary Gallia9, Robert Kerr10, Gustavo Pradilla11, Richard Rovin3, Charles Kulwin2, Julian Bailes12. 1. Division of Neurosurgery, Department of Surgery,University of Ottawa,Ottawa,On-tario, Canada. 2. Department of Neurosu-rgery, Goodman Campbell Brain and Spi-ne and Indiana University, Indianapolis, Indiana. 3. Department of Neurosurg-ery, Aurora Neuroscience and Inn-ovation Institute, Milwaukee, Wisconsin. 4. Department of Neurosurgery, Delray Medical Center, Delray Beach, Florida. 5. Department of Neurosurgery, Clear Lake Regional Medical Center, Webster, Texas. 6. Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas. 7. Department of Surgery, Otta-wa Civic Hospital, Ottawa, Ontario, Canada. 8. Department of Neurosurgery, University of Arkansas for Medical Sci-ences, Little Rock, Arkansas. 9. Depart-ment of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland. 10. Depart-ment of Neurosurgery, North Shore-LIJ/Huntington Hospital, Huntington, New York. 11. Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia. 12. Department of Neuro-surgery, NorthShore University Health-System, Evanston, Illinois.
Abstract
BACKGROUND: Subcortical injury resulting from conventional surgical management of intracranial hemorrhage may counteract the potential benefits of hematoma evacuation. OBJECTIVE: To evaluate the safety and potential benefits of a novel, minimally invasive approach for clot evacuation in a multicenter study. METHODS: The integrated approach incorporates 5 competencies: (1) image interpretation and trajectory planning, (2) dynamic navigation, (3) atraumatic access system (BrainPath, NICO Corp, Indianapolis, Indiana), (4) extracorporeal optics, and (5) automated atraumatic resection. Twelve neurosurgeons from 11 centers were trained to use this approach through a continuing medical education-accredited course. Demographical, clinical, and radiological data of patients treated over 2 years were analyzed retrospectively. RESULTS: Thirty-nine consecutive patients were identified. The median Glasgow Coma Scale (GCS) score at presentation was 10 (range, 5-15). The thalamus/basal ganglion regions were involved in 46% of the cases. The median hematoma volume and depth were 36 mL (interquartile range [IQR], 27-65 mL) and 1.4 cm (IQR, 0.3-2.9 cm), respectively. The median time from ictus to surgery was 24.5 hours (IQR, 16-66 hours). The degree of hematoma evacuation was ≥90%, 75% to 89%, and 50% to 74% in 72%, 23%, and 5.0% of the patients, respectively. The median GCS score at discharge was 14 (range, 8-15). The improvement in GCS score was statistically significant ( P < .001). Modified Rankin Scale data were available for 35 patients. Fifty-two percent of those patients had a modified Rankin Scale score of ≤2. There were no mortalities. CONCLUSION: The approach was safely performed in all patients with a relatively high rate of clot evacuation and functional independence.
BACKGROUND:Subcortical injury resulting from conventional surgical management of intracranial hemorrhage may counteract the potential benefits of hematoma evacuation. OBJECTIVE: To evaluate the safety and potential benefits of a novel, minimally invasive approach for clot evacuation in a multicenter study. METHODS: The integrated approach incorporates 5 competencies: (1) image interpretation and trajectory planning, (2) dynamic navigation, (3) atraumatic access system (BrainPath, NICO Corp, Indianapolis, Indiana), (4) extracorporeal optics, and (5) automated atraumatic resection. Twelve neurosurgeons from 11 centers were trained to use this approach through a continuing medical education-accredited course. Demographical, clinical, and radiological data of patients treated over 2 years were analyzed retrospectively. RESULTS: Thirty-nine consecutive patients were identified. The median Glasgow Coma Scale (GCS) score at presentation was 10 (range, 5-15). The thalamus/basal ganglion regions were involved in 46% of the cases. The median hematoma volume and depth were 36 mL (interquartile range [IQR], 27-65 mL) and 1.4 cm (IQR, 0.3-2.9 cm), respectively. The median time from ictus to surgery was 24.5 hours (IQR, 16-66 hours). The degree of hematoma evacuation was ≥90%, 75% to 89%, and 50% to 74% in 72%, 23%, and 5.0% of the patients, respectively. The median GCS score at discharge was 14 (range, 8-15). The improvement in GCS score was statistically significant ( P < .001). Modified Rankin Scale data were available for 35 patients. Fifty-two percent of those patients had a modified Rankin Scale score of ≤2. There were no mortalities. CONCLUSION: The approach was safely performed in all patients with a relatively high rate of clot evacuation and functional independence.
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