Corrigendum to: “Technical Note: Endoscopic Evacuation of Intraventricular Hemorrhage During Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation” by Lara-Reyna et al. Neurosurgery, 2019, nyz310_805, https://doi.org/10.1093/neuros/nyz310_805

Neurosurgery ◽  
2019 ◽  
Vol 86 (3) ◽  
pp. 453-453 ◽  
Keyword(s):  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Intraventricular Hemorrhage ◽  
Technical Note ◽  
Endoscopic Evacuation

scholarly journals Technical Note: Endoscopic Evacuation of Intraventricular Hemorrhage During Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Jacques Lara-Reyna ◽  
Rui Song ◽  
Dominic A Nistal ◽  
Neha S Dangayach ◽  
J D Mocco ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Intraventricular Hemorrhage ◽  
External Ventricular Drain ◽  
Technical Note ◽  
Descriptive Statistics ◽  
Mortality And Morbidity ◽  
Endoscopic Evacuation ◽  
Hemorrhage Volume ◽  
Successful Reduction

Abstract INTRODUCTION Intraventricular hemorrhage (IVH) associated with intracerebral hemorrhage (ICH) predicts increased mortality and morbidity. The use of minimally invasive endoscopic ICH evacuation has been proposed to directly address these conditions in recent years. It is unclear if IVH evacuation should be performed during minimally invasive ICH evacuation, and if so, then with what technique. Here we present a series of minimally invasive endoscopic IVH evacuations performed concurrently with ICH evacuation. METHODS A retrospective review of a prospectively collected database was performed on patients who underwent minimally invasive endoscopic ICH evacuation from December 2015 to August 2018 in a single health system. The severity of IVH was assessed using the modified Graeb (mGraeb) score as reported by Morgan et al. Hemorrhage volume was measured using the ABC/2 method. Descriptive statistics were performed. RESULTS A total of 40 patients with ICH and concurrent IVH (41.7%) were identified in a population of 96 patients who underwent minimally invasive endoscopic evacuation for spontaneous supratentorial ICH. The average preoperative mGraeb score was 9.2, while the average postoperative mGraeb score was 6.8. Of these 40 patients, 23 (57.5%) underwent minimally invasive endoscopic IVH evacuation. An anterior approach was used in 52.2% of patients, while a posterior approach was used in 47.8% of patients. Direct ventricular access was performed in 17.4% of approaches, while a transhematomal approach was used 82.6% of the time. Successful reduction of IVH measured by mGraeb score occurred in 73.9% of cases. Seventeen percent of patients without a preoperative external ventricular drain (EVD) required an intra- or postoperative EVD and 26.1% of patients eventually needed a ventriculo-peritoneal shunt (VPS). CONCLUSION The SCUBA technique provides a high percentage of successful IVH evacuation with a subsequent low need for permanent VPS. Multiple approaches to removing IVH are possible and need further study.

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

2017 ◽  
Vol 10 (1) ◽  
pp. 66-74 ◽  
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.

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

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.

Frontal bur hole through an eyebrow incision for image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage

2012 ◽  
Vol 117 (4) ◽  
pp. 767-773 ◽  
Author(s):  
Justin A. Dye ◽  
Joshua R. Dusick ◽  
Darrin J. Lee ◽  
Nestor R. Gonzalez ◽  
Neil A. Martin
Keyword(s):  
Glasgow Coma Scale ◽  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Invasive Technique ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Midline Shift ◽  
Hematoma Volume ◽  
Coma Scale ◽  
Endoscopic Evacuation ◽  
The Mean

Object Surgical evacuation of spontaneous intracerebral hemorrhage (sICH) remains a subject of controversy. Minimally invasive techniques for hematoma evacuation have shown a trend toward improved outcomes. The aim of the present study is to describe a minimally invasive alternative for the evacuation of sICH and evaluate its feasibility. Methods The authors reviewed records of all patients who underwent endoscopic evacuation of an sICH at the UCLA Medical Center between March 2002 and March 2011. All patients in whom the described technique was used for evacuation of an sICH were included in this series. In this approach an incision is made at the superior margin of the eyebrow, and a bur hole is made in the supraorbital bone lateral to the frontal sinus. Using stereotactic guidance, the surgeon advanced the endoscopic sheath along the long axis of the hematoma and fixed it in place at two specific depths where suction was then applied until 75%–85% of the preoperatively determined hematoma volume was removed. An endoscope's camera, then introduced through the sheath, was used to assist in hemostasis. Preoperative and postoperative hematoma volumes and reduction in midline shift were calculated and recorded. Admission Glasgow Coma Scale and modified Rankin Scale (mRS) scores were compared with postoperative scores. Results Six patients underwent evacuation of an sICH using the eyebrow/bur hole technique. The mean preoperative hematoma volume was 68.9 ml (range 30.2–153.9 ml), whereas the mean postoperative residual hematoma volume was 11.9 ml (range 5.1–24.1 ml) (p = 0.02). The mean percentage of hematoma evacuated was 79.2% (range 49%–92.7%). The mean reduction in midline shift was 57.8% (p < 0.01). The Glasgow Coma Scale score improved in each patient between admission and discharge examination. In 5 of the 6 patients the mRS score improved from admission exam to last follow-up. None of the patients experienced rebleeding. Conclusions This minimally invasive technique is a feasible alternative to other means of evacuating sICHs. It is intended for anterior basal ganglia hematomas, which usually have an elongated, ovoid shape. The approach allows for an optimal trajectory to the long axis of the hematoma, making it possible to evacuate the vast majority of the clot with only one pass of the endoscopic sheath, theoretically minimizing the amount of damage to normal brain.

Functional Outcome After Minimally Invasive Endoscopic Evacuation of Thalamic Intracerebral Hemorrhage

2021 ◽  
Author(s):  
Rui Song ◽  
Muhammad Ali ◽  
Jonathan Pan ◽  
Colton Smith ◽  
Dominic A. Nistal ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Endoscopic Evacuation

Minimal craniotomy and matrix hemostatic sealant for the treatment of spontaneous supratentorial intracerebral hemorrhage

2009 ◽  
Vol 110 (5) ◽  
pp. 939-942 ◽  
Author(s):  
Roberto Gazzeri ◽  
Marcelo Galarza ◽  
Massimiliano Neroni ◽  
Alex Alfieri ◽  
Stefano Esposito
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Skin Incision ◽  
Technical Note ◽  
Vascular Anomalies ◽  
Surrounding Tissue ◽  
Intracerebral Hematoma ◽  
Bleeding Disorders ◽  
Brain Exposure

The authors describe a minimally invasive technical note for the surgical treatment of primary intracerebral hematoma. Thirty-one patients with supratentorial intracerebral hematomas and no underlying vascular anomalies or bleeding disorders underwent treatment with a single linear skin incision followed by a 3-cm craniotomy. After evacuation of the hematoma, a matrix hemostatic sealant (FloSeal) was injected into the surgical cavity, and immediate hemostasis was achieved in all cases. A second operation was necessary in only 1 case. In this preliminary experience, a small craniotomy combined with FloSeal helped to control operative bleeding, reducing brain exposure and damage to the surrounding tissue while reducing the length of the surgery.

scholarly journals Time to Evacuation and Functional Outcome After Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation

Stroke ◽  
2021 ◽  
Author(s):  
Christopher P. Kellner ◽  
Rui Song ◽  
Muhammad Ali ◽  
Dominic A. Nistal ◽  
Milan Samarage ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Intraventricular Hemorrhage ◽  
Univariate Analysis ◽  
Favorable Outcome ◽  
Long Term Outcome ◽  
Factors Associated ◽  
Increased Risk

Background and Purpose: We present a retrospective analysis of patients who underwent minimally invasive endoscopic intracerebral hemorrhage (ICH) evacuation to identify variables that were associated with long-term outcome. Methods: Minimally invasive endoscopic ICH evacuation was performed on patients with supratentorial ICH who fit prespecified clinical inclusion and exclusion criteria. Demographic, clinical, and radiographic factors previously demonstrated to impact functional outcome in ICH were included in a univariate analysis to identify factors associated with favorable outcome (modified Rankin Scale score, 0–3) at 6 months. Factors associated with a favorable outcome in the univariate analysis ( P ≤0.20) were included in a multivariate logistic regression analysis with the same dependent variable. Results: Ninety patients underwent MIS endoscopic ICH evacuation within 72 hours of ictus. In a multivariate analysis, factors associated with good long-term functional outcome included time to evacuation (per hour; OR, 0.95 [95% CI, 0.92–0.98], P =0.004), age (per decade, odds ratio [OR], 0.49 [95% CI, 0.28–0.77], P =0.005), presence of intraventricular hemorrhage (OR, 0.15 [95% CI, 0.04–0.47], P =0.002), and lobar location (OR, 18.5 [95% CI, 4.5–103], P =0.0005). Early evacuation was not associated with an increased risk of rebleeding. Conclusions: Young age, lack of intraventricular hemorrhage, lobar location, and time to evacuation were independently associated with good long-term functional outcome in patients undergoing minimally invasive endoscopic ICH evacuation. The OR for time to evacuation suggests that for each additional hour, there was a 5% reduction in the odds of achieving a favorable outcome.

scholarly journals Long-term functional outcome following minimally invasive endoscopic intracerebral hemorrhage evacuation

2020 ◽  
Vol 12 (5) ◽  
pp. 489-494 ◽  
Author(s):  
Christopher P Kellner ◽  
Rui Song ◽  
Jonathan Pan ◽  
Dominic A Nistal ◽  
Jacopo Scaggiante ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Healthcare System ◽  
Secondary Brain Injury ◽  
Primary Analysis ◽  
Exclusion Criteria ◽  
Endoscopic Evacuation ◽  
Clot Burden ◽  
The Mean

Background and purposePreclinical studies suggest that clot removal may mitigate primary and secondary brain injury following intracerebral hemorrhage (ICH). Although the MISTIE trial did not demonstrate an overall outcome benefit, it did demonstrate outcome benefit from effective reduction of clot burden. Minimally invasive endoscopic ICH evacuation may provide an alternative option for clot evacuation.MethodsPatients presenting to a single healthcare system from December 2015 to October 2018 with supratentorial spontaneous ICH were evaluated for minimally invasive endoscopic evacuation. Inclusion and exclusion criteria were prospectively established by a multidisciplinary group in the healthcare system. The prespecified primary analysis was the proportion of patients with modified Rankin Score (mRS) 0–3 at 6 months.ResultsOne hundred patients met the inclusion and exclusion criteria and underwent minimally invasive endoscopic ICH evacuation. The mean (SD) hematoma size was 49.7 (30.6) mL, the mean (SD) evacuation percentage was 88.2 (20.3)%, and 86% of patients had postoperative residual hematoma ≤15 mL. At 6 months the proportion of patients with an mRS of 0–3 was 46%.ConclusionsThis study suggests that minimally invasive endoscopic ICH evacuation may produce favorable long-term functional outcomes. Further evaluation of this technique in a randomized clinical trial is necessary.

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