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Published on: August 11, 2015
Minimally invasive surgiscopic evacuation of intracerebral hemorrhage
Zachary Troiani1, Luis C Ascanio2, Kurt A Yaeger2
1Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA zachtroiani@gmail.com.
Insights
Minimally invasive surgery for intracerebral hemorrhage (ICH) offers a potential benefit. This video demonstrates a surgiscopic technique for clot evacuation, aiming to reduce brain injury from stroke.
Area of Science:
- Neurosurgery
- Neurology
- Minimally Invasive Surgery
Background:
- Intracerebral hemorrhage (ICH) is a severe stroke type with high mortality and functional dependence rates.
- The efficacy of surgical intervention for ICH remains a subject of debate.
- Preclinical evidence suggests minimally invasive clot removal may alleviate primary and secondary brain damage.
Observation:
- This video details the surgical technique for minimally invasive clot evacuation in ICH patients.
- A presurgical approach utilizes volumetric imaging and stereotactic guidance.
- The procedure involves direct surgiscopic visualization for evacuating intraparenchymal and intraventricular hemorrhage components.
Findings:
- Hemostasis is achieved through direct cauterization of bleeding vessels.
- Irrigation confirms the absence of fresh blood in the clot cavity.
- Radiographic evidence shows significant reduction in clot burden post-evacuation.
Implications:
- This technique offers a visual guide for performing minimally invasive ICH clot evacuation.
- Successful clot burden mitigation may improve patient outcomes after stroke.
- Further research can explore the clinical benefits of this surgical approach.
Abstract:
Intracerebral hemorrhage (ICH) is a devastating form of stroke associated with a 40% mortality rate at 30 days and a 75% functional dependence rate at 6 months. The role of surgery to treat ICH remains controversial. Preclinical studies suggest minimally invasive clot evacuation following ICH may benefit patients by mitigating primary and secondary brain injury.1 2 In this video, we report the operative technique used in minimally invasive surgicsopic evacuation following ICH (video 1). We demonstrate our presurgical approach using preoperative volumetric imaging loaded onto a stereotactic guidance system. Evacuation of intraparenchymal and intraventricular components of a hemorrhage are shown under direct surgiscopic vision using the Aurora System (Integra LifeSciences, Princeton, NJ, USA). Hemostasis is achieved when actively bleeding vessels are directly cauterized and irrigation of the clot cavity yields no fresh blood. Pre- and postevacuation radiographic differences illustrate the mitigation of clot burden in an elderly patient. neurintsurg;13/4/400/V1F1V1Video 1.
