Feasibility of intraoperative computed tomography for endoscopic-assisted intraparenchymal hemorrhage evacuation

Minimally-invasive intraparenchymal hemorrhage (IPH) evacuation may provide a functional and mortality benefit, especially if there is minimal residual hematoma. Several methods have been used to confirm extent of IPH evacuation, including intraoperative computed tomography (CT). We sought to evaluate the feasibility of intraoperative CT in endoscopic-assisted IPH evacuation, with a focus on the operative workflow and imaging quality.

We retrospectively reviewed all endoscopic-assisted IPH evacuation procedures utilizing intraoperative CT performed at our institution over a 9-month period. We describe the operative room setup and workflow for using intraoperative CT and compare the intra- and postoperative imaging findings.

Eight consecutive procedures were included in this study. Intraoperative CT provided useful information that informed intraoperative decision-making in each case. There were no clinically significant differences in residual hematoma volume or midline shift between intra- and postoperative CT scans. Streak artifact was present in all cases due to the head holder, but did not significantly inhibit image evaluation.

Intraoperative CT is an effective method of evaluating the extent of IPH evacuation in endoscopic-assisted procedures.