Stereotactic aspiration of spontaneous intracerebral hematoma: Case series

Abstract BACKGROUND Surgical options for patients with thalamic brain tumors are limited. Traditional surgical resection is associated with a high degree of morbidity and mortality. Laser interstitial thermal therapy (LITT) utilizes a stereotactically placed laser probe to induce thermal damage to tumor tissue. LITT provides a surgical cytoreduction option for this challenging patient population. We present our experience treating thalamic brain tumors with LITT. OBJECTIVE To describe our experience and outcomes using LITT on patients with thalamic tumors. METHODS We analyzed 13 consecutive patients treated with LITT for thalamic tumors from 2012 to 2017. Radiographic, clinical characteristics, and outcome data were collected via review of electronic medical records RESULTS Thirteen patients with thalamic tumors were treated with LITT. Most had high-grade gliomas, including glioblastoma (n = 9) and anaplastic astrocytoma (n = 2). The average tumor volume was 12.0 cc and shrank by 42.9% at 3 mo. The average hospital stay was 3.0 d. Median ablation coverage as calculated by thermal damage threshold (TDT) lines was 98% and 95% for yellow (>43°C for >2 min) or blue (>10 min), respectively. Median disease-specific progression-free survival calculated for 8 patients in our cohort was 6.1 mo (range: 1.1-15.1 mo). There were 6 patients with perioperative morbidity and 2 perioperative deaths because of intracerebral hematoma. CONCLUSION LITT is a feasible treatment for patients with thalamic tumors. LITT offers a cytoreduction option in this challenging population. Patient selection is key. Close attention should be paid to lesion size to minimize morbidity. More studies comparing treatment modalities of thalamic tumors need to be performed.

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Arachnoid cysts: case series and review of the literature

Neurosurgical FOCUS ◽

10.3171/foc.2007.22.2.7 ◽

2007 ◽

Vol 22 (2) ◽

pp. 1-4 ◽

Cited By ~ 101

Author(s):

Gustavo Pradilla ◽

George Jallo

Keyword(s):

Case Series ◽

Cerebrospinal Fluid Leak ◽

Senior Author ◽

Arachnoid Cysts ◽

Treatment Modalities ◽

Johns Hopkins Hospital ◽

Shunt Insertion ◽

Stereotactic Aspiration ◽

Recent Advances ◽

Spinal Cysts

Object Arachnoid cysts are commonly encountered fluid collections in the central nervous system. Recent advances in neuroimaging have translated into an increased detection of these cysts; that is, diagnoses can be made more frequently at earlier stages. Significant advances have also been made in the surgical management of these lesions. The authors report on a case series that illustrates the diverse forms of presentation and the treatment modalities commonly used for arachnoid cysts. Methods Between January 2002 and December 2006, 20 patients with arachnoid cysts underwent surgery performed by the senior author at The Johns Hopkins Hospital. Seventy percent of the cysts were supratentorial, 5% infratentorial, and 25% spinal. All diagnoses were confirmed on neuroimaging, surgery, and histological examination. Included in the study were 12 male (60%) and eight female (40%) patients, ranging in age from 2 weeks to 39 years (mean age 10.9 years) at the time of surgery. Symptoms at presentation included headache (41%), weakness (23%), seizure (14%), hydrocephalus (9%), scoliosis (4%), cognitive decline (4%), and visual loss (4%). Twenty-five percent of the cysts were sylvian, 20% intraventricular, and 20% suprasellar. Supratentorial cysts were treated endoscopically in 73% of patients and with open resection in the remaining 27%. Complications included spasticity, hemiparesis, cerebrospinal fluid leak, hydrocephalus, and subdural hygroma. On follow-up evaluation, 60% of patients had stable cysts and improved symptoms, 13% complete symptom resolution, and 13% stable symptoms. All patients with spinal cysts underwent laminectomies and fenestration, and one cystosubarachnoid (CS) shunt was placed. Cyst reaccumulation occurred in three patients; two patients required cystoperitoneal (CP) and CS shunts. No deaths occurred. Conclusions Most arachnoid cysts are found incidentally and can be managed conservatively. Symptomatic patients are surgical candidates. Treatments include CP shunt placement, craniotomy, or endoscopic fenestration, and stereotactic aspiration. Recent advances in neurosurgical techniques and neuroendoscopy continue to favor fenestration over shunt insertion as the method of choice for initial cyst decompression.

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Stereotactic aspiration of enlarged intracerebral hematoma caused by intraprocedural perforation of aneurysm during coil embolization

Surgical Neurology ◽

10.1016/j.surneu.2007.03.045 ◽

2008 ◽

Vol 69 (6) ◽

pp. 633-635 ◽

Cited By ~ 1

Author(s):

Cheng-Ta Hsieh ◽

Chung-Che Wu ◽

Yung-Hsiao Chiang ◽

Cheng-Fu Chang

Keyword(s):

Coil Embolization ◽

Intracerebral Hematoma ◽

Stereotactic Aspiration

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Post Traumatic Chronic Encapsulated Intracerebral Hematoma in a Child: Case Report and Brief Review of Literature

Nepal Journal of Neuroscience ◽

10.3126/njn.v14i3.20527 ◽

2017 ◽

Vol 14 (3) ◽

pp. 46-48

Author(s):

Yam Bahadur Roka ◽

Mohan Karki

Keyword(s):

Case Report ◽

Clinical Symptoms ◽

Neurological Deficits ◽

Intracerebral Hematoma ◽

Diagnostic Modality ◽

Ct Guided ◽

Stereotactic Aspiration ◽

First Case ◽

History Of ◽

One Year

Chronic encapsulated intracerebral hematoma (CE-ICH) is an uncommon pathology that presents with headache, seizure, focal neurological deficits, or as a tumor. Trauma as a cause for CE-ICH is even rare and we believe this is the first case report as “trauma causing chronic encapsulated intracerebral hematoma “search in PubMed did not reveal any results. Repeated micro-hemorrhages in the CM or AVM are supposed to cause this lesion which progress from an earlier encapsulated phase to a thick capsulated stage with edema and clinical symptoms. CT or MRI is the diagnostic modality and it mimics, tumor, AVM, CM, angiomableed, cerebral abscess, metastatic mass or neurocysticercosis. Burr hole, mini-craniotomy, craniotomy, CT guided stereotactic aspiration or endoscopic excision are some options with equally good results. The present case with history of trauma was managed successfully with craniotomy with no recurrence for past one year. Nepal Journal of Neuroscience, Volume 14, Number 3, 2017, page: 46-48

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Results of Stereotactic Aspiration in 175 Cases of Putaminal Hemorrhage

Neurosurgery ◽

10.1227/00006123-198906000-00005 ◽

1989 ◽

Vol 24 (6) ◽

pp. 814-819 ◽

Cited By ~ 63

Author(s):

Hiroshi Niizuma ◽

Yukihiko Shimizu ◽

Tsutomu Yonemitsu ◽

Nobukazu Nakasato ◽

Jiro Suzuki

Keyword(s):

Intracerebral Hematoma ◽

Entire Series ◽

Stereotactic Aspiration ◽

Computed Tomographic ◽

Consciousness Level ◽

Therapeutic Results ◽

Putaminal Hemorrhage ◽

Minimal Invasion ◽

The Brain ◽

Definite Role

Abstract Believing that improved therapeutic results in cases of intracerebral hematoma might be obtained by minimal invasion of the brain, we used computed tomographic-guided stereotactic aspiration in 175 of 241 patients with putaminal hemorrhage. These patients, who were treated 6 or more hours after onset, had hematomas larger than 8 ml and were unable to raise an arm and/or leg on the affected side. Craniotomy was performed in 15 other patients, most of whom were brought to the hospital with large hematomas within 6 hours of onset. The remaining patients either had mild deficits of consciousness (33 patients) or severe deficits and/or were elderly (18 patients) and were treated conservatively. Thirteen patients (7.4%) showed rebleeding after stereotactic aspiration (6 instances of major and 7 instances of minor rebleeding). Craniotomy and removal of the hematoma were required in three of these patients. Aspiration should be avoided in patients who have a tendency for bleeding, even if mild, because rebleeding occurred in 6 of 23 such patients (26%) in these study. The consciousness level improved in 66 patients (38%), was unchanged in 103 patients (59%), and was worse in 6 patients (3%) 1 week postoperatively. Motor function of the arm improved in 55 patients (31%) and was worse in 23 patients (14%). Six months after surgery, the results for the 175 patients who underwent stereotactic aspiration were: 19% excellent, 32% good, 35% fair, 7% poor, 6% dead, and 1% unknown. For the entire series of 241 patients, the results were: 24% excellent, 26% good, 31% fair, 7% poor, 11% dead, and 1% unknown. These results seem to indicate that stereotactic aspiration can play a definite role in the treatment of spontaneous intracerebral hematoma.

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Real-Time MRI–Guided Stereotactic Aspiration of Spontaneous Intracerebral Hematoma: A Preclinical Feasibility Study

Operative Neurosurgery ◽

10.1227/ons.0000000000000005 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Devi P. Patra ◽

Matthew E. Welz ◽

Evelyn L. Turcotte ◽

Rajesh Pandey ◽

Kamal Vij ◽

...

Keyword(s):

Real Time ◽

Feasibility Study ◽

Intracerebral Hematoma ◽

Stereotactic Aspiration ◽

Mri Guided

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In-Vitro Study of Urokinase Thrombolysis Following Stereotactic Aspiration of Intracerebral Hematoma

Journal of Korean Neurosurgical Society ◽

10.3340/jkns.2018.0224 ◽

2020 ◽

Vol 63 (3) ◽

pp. 380-385

Author(s):

Wonsoo Son ◽

Jaechan Park ◽

Dong-Hun Kang ◽

Young-Min Han ◽

Yeon-Ju Choi ◽

...

Keyword(s):

In Vitro Study ◽

Vitro Study ◽

Intracerebral Hematoma ◽

Stereotactic Aspiration

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Safety profile of superior petrosal vein (the vein of Dandy) sacrifice in neurosurgical procedures: a systematic review

Neurosurgical FOCUS ◽

10.3171/2018.4.focus18133 ◽

2018 ◽

Vol 45 (1) ◽

pp. E3 ◽

Cited By ~ 18

Author(s):

Vinayak Narayan ◽

Amey R. Savardekar ◽

Devi Prasad Patra ◽

Nasser Mohammed ◽

Jai D. Thakur ◽

...

Keyword(s):

Systematic Review ◽

Trigeminal Neuralgia ◽

Case Series ◽

Intracerebral Hematoma ◽

Neurosurgical Procedures ◽

Petrosal Vein ◽

Peduncular Hallucinosis ◽

Superior Petrosal Vein ◽

The Difference ◽

Meta Analyses

OBJECTIVEWalter E. Dandy described for the first time the anatomical course of the superior petrosal vein (SPV) and its significance during surgery for trigeminal neuralgia. The patient’s safety after sacrifice of this vein is a challenging question, with conflicting views in current literature. The aim of this systematic review was to analyze the current surgical considerations regarding Dandy’s vein, as well as provide a concise review of the complications after its obliteration.METHODSA systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A thorough literature search was conducted on PubMed, Web of Science, and the Cochrane database; articles were selected systematically based on the PRISMA protocol and reviewed completely, and then relevant data were summarized and discussed.RESULTSA total of 35 publications pertaining to the SPV were included and reviewed. Although certain studies report almost negligible complications of SPV sectioning, there are reports demonstrating the deleterious effects of SPV obliteration when achieving adequate exposure in surgical pathologies like trigeminal neuralgia, vestibular schwannoma, and petroclival meningioma. The incidence of complications after SPV sacrifice (32/50 cases in the authors’ series) is 2/32 (6.2%), and that reported in various case series varies from 0.01% to 31%. It includes hemorrhagic and nonhemorrhagic venous infarction of the cerebellum, sigmoid thrombosis, cerebellar hemorrhage, midbrain and pontine infarct, intracerebral hematoma, cerebellar and brainstem edema, acute hydrocephalus, peduncular hallucinosis, hearing loss, facial nerve palsy, coma, and even death. In many studies, the difference in incidence of complications between the SPV-sacrificed group and the SPV-preserved group was significant.CONCLUSIONSThe preservation of Dandy’s vein is a neurosurgical dilemma. Literature review and experiences from large series suggest that obliterating the vein of Dandy while approaching the superior cerebellopontine angle corridor may be associated with negligible complications. However, the counterview cannot be neglected in light of some series showing an up to 30% complication rate from SPV sacrifice. This review provides the insight that although the incidence of complications due to SPV obliteration is low, they can happen, and the sequelae might be worse than the natural history of the existing pathology. Therefore, SPV preservation should be attempted to optimize patient outcome.

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