Clinical and radiographic factors involved in achieving a hematoma evacuation rate of more than 70% through minimally invasive catheter drainage for spontaneous intracerebral hemorrhage

Abstract Background Minimally invasive surgery (MIS) for evacuation of spontaneous intracerebral hemorrhage (ICH) has shown promise but there remains a need for intraoperative performance assessment considering the wide range of evacuation effectiveness. In this feasibility study, we analyzed the benefit of intraoperative 3-dimensional imaging during navigated endoscopy-assisted ICH evacuation by mechanical clot fragmentation and aspiration. Methods 18 patients with superficial or deep supratentorial ICH underwent MIS for clot evacuation followed by intraoperative computerized tomography (iCT) or cone-beam CT (CBCT) imaging. Eligibility for MIS required (a) availability of intraoperative iCT or CBCT, (b) spontaneous lobar or deep ICH without vascular pathology, (c) a stable ICH volume (20–90 ml), (d) a reduced level of consciousness (GCS 5–14), and (e) a premorbid mRS ≤ 1. Demographic, clinical, and radiographic patient data were analyzed by two independent observers. Results Nine female and 9 male patients with a median age of 76 years (42–85) presented with an ICH score of 3 (1–4), GCS of 10 (5–14) and ICH volume of 54 ± 26 ml. Clot fragmentation and aspiration was feasible in all cases and intraoperative imaging determined an overall evacuation rate of 80 ± 19% (residual hematoma volume: 13 ± 17 ml; p < 0.0001 vs. Pre-OP). Based on the intraoperative imaging results, 1/3rd of all patients underwent an immediate re-aspiration attempt. No patient experienced hemorrhagic complications or required conversion to open craniotomy. However, routine postoperative CT imaging revealed early hematoma re-expansion with an adjusted evacuation rate of 59 ± 30% (residual hematoma volume: 26 ± 37 ml; p < 0.001 vs. Pre-OP). Conclusions Routine utilization of iCT or CBCT imaging in MIS for ICH permits direct surgical performance assessment and the chance for immediate re-aspiration, which may optimize targeting of an ideal residual hematoma volume and reduce secondary revision rates.

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Dual-Channel Minimally Invasive Endoscopic Port for Evacuation of Deep-Seated Spontaneous Intracerebral Hemorrhage with Obstructive Hydrocephalus

World Neurosurgery ◽

10.1016/j.wneu.2016.04.066 ◽

2016 ◽

Vol 91 ◽

pp. 452-459 ◽

Cited By ~ 6

Author(s):

Li Liu ◽

Xi Liu ◽

Fan Zhang ◽

Xianyi Yao ◽

Peng Xue ◽

...

Keyword(s):

Minimally Invasive ◽

Intracerebral Hemorrhage ◽

Obstructive Hydrocephalus ◽

Spontaneous Intracerebral Hemorrhage ◽

Dual Channel

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Factors affecting the evacuation rate of intracerebral hemorrhage in basal ganglia treated by minimally invasive craniopuncture

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2015.04.020 ◽

2015 ◽

Vol 134 ◽

pp. 104-109 ◽

Cited By ~ 1

Author(s):

Tingzhong Wang ◽

Yongchang Guan ◽

Jinghua Du ◽

Guojun Liu ◽

Fei Gao ◽

...

Keyword(s):

Basal Ganglia ◽

Minimally Invasive ◽

Intracerebral Hemorrhage ◽

Factors Affecting ◽

Evacuation Rate

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Spreading depolarizations in patients with spontaneous intracerebral hemorrhage: Association with perihematomal edema progression

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x16651269 ◽

2016 ◽

Vol 37 (5) ◽

pp. 1871-1882 ◽

Cited By ~ 16

Author(s):

Raimund Helbok ◽

Alois Josef Schiefecker ◽

Christian Friberg ◽

Ronny Beer ◽

Mario Kofler ◽

...

Keyword(s):

Brain Injury ◽

Intracerebral Hemorrhage ◽

Electrode Placement ◽

Secondary Brain Injury ◽

Spontaneous Intracerebral Hemorrhage ◽

Strip Electrode ◽

Hematoma Evacuation ◽

Perihematomal Edema ◽

Pathophysiologic Mechanisms

Pathophysiologic mechanisms of secondary brain injury after intracerebral hemorrhage and in particular mechanisms of perihematomal-edema progression remain incompletely understood. Recently, the role of spreading depolarizations in secondary brain injury was established in ischemic stroke, subarachnoid hemorrhage and traumatic brain injury patients. Its role in intracerebral hemorrhage patients and in particular the association with perihematomal-edema is not known. A total of 27 comatose intracerebral hemorrhage patients in whom hematoma evacuation and subdural electrocorticography was performed were studied prospectively. Hematoma evacuation and subdural strip electrode placement was performed within the first 24 h in 18 patients (67%). Electrocorticography recordings started 3 h after surgery (IQR, 3–5 h) and lasted 157 h (median) per patient and 4876 h in all 27 patients. In 18 patients (67%), a total of 650 spreading depolarizations were observed. Spreading depolarizations were more common in the initial days with a peak incidence on day 2. Median electrocorticography depression time was longer than previously reported (14.7 min, IQR, 9–22 min). Postoperative perihematomal-edema progression (85% of patients) was significantly associated with occurrence of isolated and clustered spreading depolarizations. Monitoring of spreading depolarizations may help to better understand pathophysiologic mechanisms of secondary insults after intracerebral hemorrhage. Whether they may serve as target in the treatment of intracerebral hemorrhage deserves further research.

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A review and comparison of three neuronavigation systems for minimally invasive intracerebral hemorrhage evacuation

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2017-013091 ◽

2017 ◽

Vol 10 (1) ◽

pp. 66-74 ◽

Cited By ~ 11

Author(s):

Alexander G Chartrain ◽

Christopher P Kellner ◽

Kyle M Fargen ◽

Alejandro M Spiotta ◽

David A Chesler ◽

...

Keyword(s):

Minimally Invasive ◽

Intracerebral Hemorrhage ◽

Navigation System ◽

Minimally Invasive Techniques ◽

Catheter Drainage ◽

Advantages And Disadvantages ◽

Stereotactic Navigation ◽

Endoscopic Evacuation ◽

Invasive Techniques ◽

Neurosurgical Techniques

Advances in stereotactic navigation technology have helped to improve the ease, reliability, and workflow of neurosurgical intraoperative navigation. These advances have also allowed novel, minimally invasive neurosurgical techniques to emerge. Minimally invasive techniques for intracerebral hemorrhage (ICH) evacuation, including endoscopic evacuation and passive catheter drainage, are notable examples, and as these gain support in the literature and their use expands, stereotactic navigation will take on an increasingly important and central role. Each neurosurgical navigation system has unique characteristics. Operators may find that certain aspects are more important than others, depending on the environment in which the evacuation is performed and operator preferences. This review will describe the characteristics of three popular stereotactic neuronavigation systems and compare their advantages and disadvantages as they relate to minimally invasive ICH evacuation.

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Minimally invasive endoscopic hematoma evacuation vs best medical management for spontaneous basal-ganglia intracerebral hemorrhage

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014447 ◽

2019 ◽

Vol 11 (6) ◽

pp. 579-583 ◽

Cited By ~ 7

Author(s):

Nitin Goyal ◽

Georgios Tsivgoulis ◽

Konark Malhotra ◽

Aristeidis H Katsanos ◽

Abhi Pandhi ◽

...

Keyword(s):

Basal Ganglia ◽

Minimally Invasive ◽

Intracerebral Hemorrhage ◽

Hospital Mortality ◽

Medical Management ◽

Intervention Group ◽

Stroke Severity ◽

Hematoma Evacuation ◽

Discharge Disposition ◽

Relative Safety

BackgroundWe conducted a case-control study to assess the relative safety and efficacy of minimally invasive endoscopic surgery (MIS) for clot evacuation in patients with basal-ganglia intracerebral hemorrhage (ICH).MethodsWe evaluated consecutive patients with acute basal-ganglia ICH at a single center over a 42-month period. Patients received either best medical management according to established guidelines (controls) or MIS (cases). The following outcomes were compared before and after propensity-score matching (PSM): in-hospital mortality; discharge National Institutes of Health Stroke Scale score; discharge disposition; and modified Rankin Scale scores at discharge and at 3 months.ResultsAmong 224 ICH patients, 19 (8.5%) underwent MIS (mean age, 50.9±10.9; 26.3% female, median ICH volume, 40 (IQR, 25–51)). The interventional cohort was younger with higher ICH volume and stroke severity compared with the medically managed cohort. After PSM, 18 MIS patients were matched to 54 medically managed individuals. The two cohorts did not differ in any of the baseline characteristics. The median ICH volume at 24 hours was lower in the intervention group (40 cm3 (IQR, 25–50) vs 15 cm3 (IQR, 5–20); P<0.001). The two cohorts did not differ in any of the pre-specified outcomes measures except for in-hospital mortality, which was lower in the interventional cohort (28% vs 56%; P=0.041).ConclusionsMinimally invasive endoscopic hematoma evacuation was associated with lower rates of in-hospital mortality in patients with spontaneous basal-ganglia ICH. These findings support a randomized controlled trial of MIS versus medical management for ICH.

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P.104 Peri-cavity atrophy after minimally invasive evacuation of intracerebral hemorrhage

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2018.206 ◽

2018 ◽

Vol 45 (s2) ◽

pp. S43-S44

Author(s):

S Ahmed ◽

J Scaggiante ◽

J Mocco ◽

C Kellner

Keyword(s):

Minimally Invasive ◽

Intracerebral Hemorrhage ◽

Surgical Techniques ◽

Ct Scans ◽

Cavity Volume ◽

Cavity Size ◽

Hematoma Evacuation ◽

Endoscopic Evacuation ◽

Invasive Techniques

Background: Intracerebral hemorrhage (ICH) remains a significant cause of morbidity and mortality. While traditional surgical techniques have shown marginal clinical benefit of ICH evacuation, minimally invasive techniques have shown some promise. Endoscopic evacuation of the hemorrhage may reduce the peri-hematoma edema and subsequent atrophy around the hemorrhage cavity. This study aims to quantify the changes in cavity volume following hematoma evacuation. Methods: Patients from the INVEST registry of minimally invasive ICH evacuation were included retrospectively if follow-up computed tomography (CT) scans were available for analysis. Hematoma cavity volumes were calculated from the immediate post-procedural and three-month follow-up CT scans using the Analyze Pro software. Results: Twenty patients had follow-up CT scans at a mean time of 93 days from hematoma evacuation. The average cavity size at follow-up was 11938.12 mm3 (SD: 6996.49). The change in cavity size compared to the prior CT was 6396.74 mm3 (median 2542; range: -1030-27543; SD: 8472.45). This represented mean growth in cavity volume of 54%. Conclusions: This study provides preliminary data describing increase in cavity size after endoscopic minimally invasive evacuation of ICH. Comparison to atrophy in conservatively-managed patients is a further planned avenue of research.

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