The safety and feasibility of image-guided brainpath-mediated transsulcul hematoma evacuation: A multicenter study

Mohamed A. Labib, Mitesh Shah, Amin B. Kassam, Ronald Young, Lloyd Zucker, Anthony Maioriello, Gavin Britz, Charles Agbi, Jd Day, Gary Gallia, Robert Kerr, Gustavo Pradilla, Richard Rovin, Charles Kulwin, Julian Bailes

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42 Scopus citations

Abstract

BACKGROUND: Subcortical injury resulting from conventional surgical management of intracranial hemorrhage may counteract the potential benefts of hematoma evacuation. OBJECTIVE: To evaluate the safety and potential benefts of a novel, minimally invasive approach for clot evacuation in a multicenter study. METHODS: The integrated approach incorporates 5 competencies: (1) image interpretation and trajectory planning, (2) dynamic navigation, (3) atraumatic access system (BrainPath, NICO Corp, Indianapolis, Indiana), (4) extracorporeal optics, and (5) automated atraumatic resection. Twelve neurosurgeons from 11 centers were trained to use this approach through a continuing medical education-accredited course. Demographical, clinical, and radiological data of patientstreated over 2 yearswere analyzed retrospectively. RESULTS: Thirty-nine consecutive patients were identifed. The median Glasgow Coma Scale (GCS) score at presentation was 10 (range, 5-15). The thalamus/basal ganglion regions were involved in 46% of the cases. The median hematoma volume and depth were 36 mL (interquartile range [IQR], 27-65 mL) and 1.4 cm (IQR, 0.3-2.9 cm), respectively. The median time from ictus to surgery was 24.5 hours (IQR, 16-66 hours). The degree of hematoma evacuation was =90%, 75% to 89%, and 50% to 74% in 72%, 23%, and 5.0% of the patients, respectively. The median GCS score at discharge was 14 (range, 8-15). The improvement in GCS score was statistically signifcant (P < .001). Modifed Rankin Scale data were available for 35 patients. Fifty-two percent of those patients had a modifed Rankin Scale score of =2. There were no mortalities. CONCLUSION: The approach was safely performed in all patients with a relatively high rate of clot evacuation and functional independence.

Original languageEnglish (US)
Pages (from-to)515-524
Number of pages10
JournalNeurosurgery
Volume80
Issue number4
DOIs
Publication statusPublished - Jan 1 2017
Externally publishedYes

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Keywords

  • Intracerebral hemorrhage
  • Minimally invasive clot evacuation
  • Stroke
  • Surgery
  • Transsulcul

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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