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 Technical Notes and Result of Stereotactic Evacuation of Hematoma in Spontaneous Supratentorial Intracerebral Hematoma

2018 ◽  
Vol 15 (3) ◽  
pp. 27-31
Author(s):  
Resha Shrestha ◽  
Pranaya Shrestha ◽  
Pravesh Rajbhandari ◽  
Samir Acharya ◽  
Sudan Dhakal ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Surgical Treatment ◽  
Minimal Invasive ◽  
Technical Note ◽  
Stereotactic Surgery ◽  
Intracerebral Hematoma ◽  
Modified Rankin Scale ◽  
Hematoma Volume ◽  
Baseline Characteristics

Primary intracerebral hematoma constitutes about 10-15% of all strokes and is associated with high mortality and severe disability. Surgical treatment of intracerebral hemorrhage is quite controversial. It is believed that minimal invasive stereotactic surgery may reduce hematoma volume and decrease secondary neurotoxicity. The technical note of stereotactic surgery has been illustrated. A retrospective study from March 2016 to March 2018 has been conducted and all patients who underwent stereotactic evacuation of hematoma were included in this study. Baseline characteristics of patients and outcome in terms of Glasgow Coma Scale (GCS) and Modified Rankin Scale (mRS) have been shown. We have found significant improvement in GCS postoperatively, however mRS did not improve immediately but was significantly better in three months follow up period.

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.

scholarly journals Recent Updates in Neurosurgical Interventions for Spontaneous Intracerebral Hemorrhage: Minimally Invasive Surgery to Improve Surgical Performance

2021 ◽  
Vol 12 ◽  
Author(s):  
Hitoshi Kobata ◽  
Naokado Ikeda
Keyword(s):  
Minimally Invasive Surgery ◽  
Surgical Treatment ◽  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Invasive Surgery ◽  
Functional Improvement ◽  
Minimally Invasive Procedures ◽  
Invasive Procedures ◽  
Surgical Performance ◽  
Significant Information

The efficacy and safety of surgical treatment for intracerebral hemorrhage (ICH) have long been subjects of investigation and debate. The recent results of the minimally invasive surgery plus alteplase for intracerebral hemorrhage evacuation (MISTIE) III trial demonstrated the safety of the procedure and a reduction in mortality compared to medical treatment. Although no improvement in functional outcomes was shown, the trial elucidated that benefits of intervention depend on surgical performance: a greater ICH reduction, defined as ≤ 15 mL end of treatment ICH volume or ≥70% volume reduction, correlated with significant functional improvement. Recent meta-analyses suggested the benefits of neurosurgical hematoma evacuation, especially when performed earlier and done using minimally invasive procedures. In MISTIE III, to confirm hemostasis and reduce the risk of rebleeding, the mean time from onset to surgery and treatment completion took 47 and 123 h, respectively. Theoretically, the earlier the hematoma is removed, the better the outcome. Therefore, a higher rate of hematoma reduction within an earlier time course may be beneficial. Neuroendoscopic surgery enables less invasive removal of ICH under direct visualization. Minimally invasive procedures have continued to evolve with the support of advanced guidance systems and devices in favor of better surgical performance. Ongoing randomized controlled trials utilizing emerging minimally invasive techniques, such as the Early Minimally Invasive Removal of Intra Cerebral Hemorrhage (ENRICH) trial, Minimally Invasive Endoscopic Surgical Treatment with Apollo/Artemis in Patients with Brain Hemorrhage (INVEST) trial, and the Dutch Intracerebral Hemorrhage Surgery Trial (DIST), may provide significant information on the optimal treatment for ICH.

Eyebrow Surgery: The Supraciliary Craniotomy: Technical Note

2006 ◽  
Vol 59 (suppl_1) ◽  
pp. ONS-E157-ONS-E158 ◽  
Author(s):  
George I. Jallo ◽  
László Bognár
Keyword(s):  
Minimally Invasive ◽  
Traditional Approach ◽  
Middle Cranial Fossa ◽  
Skin Incision ◽  
Technical Note ◽  
Minimally Invasive Technique ◽  
Invasive Technique ◽  
Clear Understanding ◽  
Cranial Fossa ◽  
Keyhole Craniotomy

Abstract OBJECTIVE: Many approaches have been recommended for the surgical treatment of anterior and middle cranial fossa lesions. The frontobasal approach and its many modifications have been proposed and developed for such situated lesions. An alternative approach is the frontolateral craniotomy through a supraciliary skin incision. METHODS: This minimally invasive technique, a 2.5 × 3.0 cm craniotomy, just above the eyebrow through a supraciliary incision, is a simple but elegant modification of the traditional approach to the anterior cranial fossa. RESULTS: A step-by-step description of the approach is offered in this report to facilitate a clear understanding of the lesions treatable with this minimally invasive technique. CONCLUSION: The supraciliary frontolateral keyhole craniotomy is a minimally invasive cosmetic approach that provides excellent exposure to a variety of intracranial lesions. This approach cannot be used for all intracranial pathologies, but is recommended for many anterior and middle cranial fossa lesions.

Minimally Invasive Repair of Pectus Excavatum (MIRPE) - The Basel Experience

Swiss Surgery ◽  
2003 ◽  
Vol 9 (6) ◽  
pp. 289-295 ◽  
Author(s):  
Haecker ◽  
Bielek ◽  
von Schweinitz
Keyword(s):  
Minimally Invasive ◽  
Pectus Excavatum ◽  
Pulmonary Function Tests ◽  
Preoperative Evaluation ◽  
Skin Incision ◽  
Original Method ◽  
Restrictive Lung Disease ◽  
Cardiac Compression ◽  
Cardiac Evaluation ◽  
Indications For Operation

Purpose: Minimally invasive repair of pectus excavatum (MIRPE) was first reported in 1998 by D. Nuss. This technique has gained wide acceptance during the last 4-5 years. In the meantime, some modifications of the technique have been introduced by different authors. Our retrospective study reports our own experience over the last 36 months and modifications introduced due to a number of complications. Methods: From 3/2000 to 3/2003, 22 patients underwent MIRPE. Patients median age was 15.5 years (10.7 to 20.3 years). Standardised preoperative evaluation included 3D computerised tomography (CT) scan, pulmonary function tests, cardiac evaluation with electrocardiogram and echocardiography, and photo documentation. Indications for operation included at least two of the following: Haller CT index > 3.2, restrictive lung disease, cardiac compression, progression of the deformity and severe psychological alterations. Results: In 22 patients (2 girls, 20 boys) undergoing MIRPE procedure, a single bar was used in 21 patients and two bars in one boy. Lateral stabilisers were fixed with non resorbable sutures on both sides. Overall, postoperative complications occurred in six patients (27.3%). In two patients (9.1%) a redo-procedure was necessary due to bar displacement. An additional median skin incision was performed in two patients to elevate the sternum. Pneumothorax or hematothorax in two patients resulted in routine use of a chest tube on both sides. Long-term favourable results were noted in all patients. Conclusions: The MIRPE procedure is an effective method with elegant cosmetic results. Modifications of the original method help to decrease the complication rate and to accelerate acquirement of expertise.

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