Usefulness of intraoperative computed tomography for the evacuation of lobar hemorrhage

There is a lot of debate on the treatment method for spontaneous intracerebral hemorrhage (ICH). Intraoperative computed tomography (iCT) provides excellent images of cerebrovascular lesions. In this paper, we describe the surgical procedure and the efficacy of iCT during lobar hemorrhage evacuations and subsequent patient outcomes. Fifty-eight patients with lobar hemorrhage were treated using iCT. We performed preoperative cerebral angiography and/or three-dimensional (3D) CT angiography to detect abnormal vessels and identify the spatial relationships between the cerebrovascular structures and the hematoma. After administration of local anesthesia, an enlarged burr-hole was created just above the hematoma. Microsurgical evacuation of the hematoma was performed, and an iCT image was obtained to assess real-time 3D information on residual hematoma or unexpected rebleeding. Mean hematoma volume, evacuation rate, and duration of the surgery were 42 mL, 93 %, and 89 min respectively. Postoperative rebleeding occurred in 1 case. The median Glasgow Coma Scale score upon admission was 12. At discharge, most patients (60 %) had good functional outcomes defined by modified Rankin Scale scores of 0-3. Postoperative neurological findings and consciousness levels showed early improvement. Safe, accurate, and effective evacuation of lobar hemorrhage was possible with iCT as an image-guided intraoperative navigation tool.