scholarly journals Advanced Techniques for Endoscopic Intracerebral Hemorrhage Evacuation: A Technical Report With Case Examples

2020 ◽  
Vol 20 (1) ◽  
pp. 119-129
Author(s):  
Robert J Rothrock ◽  
Alexander G Chartrain ◽  
Jacopo Scaggiante ◽  
Jonathan Pan ◽  
Rui Song ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Health System ◽  
Surgical Techniques ◽  
Collateral Damage ◽  
Single Center ◽  
Safety And Efficacy ◽  
Case Examples ◽  
Technical Report

Abstract BACKGROUND Multiple surgical techniques to perform minimally invasive intracerebral hemorrhage (ICH) evacuation are currently under investigation. The use of an adjunctive aspiration device permits controlled suction through an endoscope, minimizing collateral damage from the access tract. As with increased experience with any new procedure, performance of endoscopic minimally invasive ICH evacuation requires development of a unique set of operative tenets and techniques. OBJECTIVE To describe operative nuances of endoscopic minimally invasive ICH evacuation developed at a single center over an experience of 80 procedures. METHODS Endoscopic minimally invasive ICH evacuation was performed on 79 consecutive eligible patients who presented a single Health System between March 2016 and May 2018. We summarize 4 core operative tenets and 4 main techniques used in 80 procedures. RESULTS A total of 80 endoscopic minimally invasive ICH evacuations were performed utilizing the described surgical techniques. The average preoperative and postoperative volumes were 49.5 mL (standard deviation [SD] 31.1 mL, interquartile range [IQR] 30.2) and 5.4 mL (SD 9.6, mL IQR 5.1), respectively, with an average evacuation rate of 88.7%. All cause 30-d mortality was 8.9%. CONCLUSION As experience builds with endoscopic minimally invasive ICH evacuation, academic discussion of specific surgical techniques will be critical to maximizing its safety and efficacy.

scholarly journals P.104 Peri-cavity atrophy after minimally invasive evacuation of intracerebral hemorrhage

2018 ◽  
Vol 45 (s2) ◽  
pp. S43-S44
Author(s):  
S Ahmed ◽  
J Scaggiante ◽  
J Mocco ◽  
C Kellner
Keyword(s):  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Surgical Techniques ◽  
Ct Scans ◽  
Cavity Volume ◽  
Cavity Size ◽  
Hematoma Evacuation ◽  
Endoscopic Evacuation ◽  
Invasive Techniques

Background: Intracerebral hemorrhage (ICH) remains a significant cause of morbidity and mortality. While traditional surgical techniques have shown marginal clinical benefit of ICH evacuation, minimally invasive techniques have shown some promise. Endoscopic evacuation of the hemorrhage may reduce the peri-hematoma edema and subsequent atrophy around the hemorrhage cavity. This study aims to quantify the changes in cavity volume following hematoma evacuation. Methods: Patients from the INVEST registry of minimally invasive ICH evacuation were included retrospectively if follow-up computed tomography (CT) scans were available for analysis. Hematoma cavity volumes were calculated from the immediate post-procedural and three-month follow-up CT scans using the Analyze Pro software. Results: Twenty patients had follow-up CT scans at a mean time of 93 days from hematoma evacuation. The average cavity size at follow-up was 11938.12 mm3 (SD: 6996.49). The change in cavity size compared to the prior CT was 6396.74 mm3 (median 2542; range: -1030-27543; SD: 8472.45). This represented mean growth in cavity volume of 54%. Conclusions: This study provides preliminary data describing increase in cavity size after endoscopic minimally invasive evacuation of ICH. Comparison to atrophy in conservatively-managed patients is a further planned avenue of research.

Analysis of Electrode Degradation Through the Use of Synthetic Tissue Analog

2009 ◽  
Author(s):  
Mason J. Webster ◽  
Derek M. Herbert ◽  
Peter T. Pascoal ◽  
Justin C. Smith
Keyword(s):  
Minimally Invasive ◽  
Surgical Techniques ◽  
Clinical Use ◽  
Minimally Invasive Procedures ◽  
Rf Ablation ◽  
Invasive Procedures ◽  
Safety And Efficacy ◽  
Electrode Degradation ◽  
The World ◽  
Porcine Tissues

RF Ablation Efficacy Testing: Modern surgical techniques utilize radio frequency ablation tools in minimally invasive procedures around the world today. The safety and efficacy of these tools must be verified before being used in human trials. This verification is typically performed on bovine, ovine, or porcine tissues which simulate clinical use.

Minimally invasive treatment of intracerebral hemorrhage with magnetic resonance–guided focused ultrasound

2013 ◽  
Vol 118 (5) ◽  
pp. 1035-1045 ◽  
Author(s):  
Stephen J. Monteith ◽  
Sagi Harnof ◽  
Ricky Medel ◽  
Britney Popp ◽  
Max Wintermark ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Focused Ultrasound ◽  
Safety Data ◽  
Surgical Techniques ◽  
Minimally Invasive Treatment ◽  
Swine Model ◽  
Invasive Treatment

Object Intracerebral hemorrhage (ICH) is a major cause of death and disability throughout the world. Surgical techniques are limited by their invasive nature and the associated disability caused during clot removal. Preliminary data have shown promise for the feasibility of transcranial MR-guided focused ultrasound (MRgFUS) sonothrombolysis in liquefying the clotted blood in ICH and thereby facilitating minimally invasive evacuation of the clot via a twist-drill craniostomy and aspiration tube. Methods and Results In an in vitro model, the following optimum transcranial sonothrombolysis parameters were determined: transducer center frequency 230 kHz, power 3950 W, pulse repetition rate 1 kHz, duty cycle 10%, and sonication duration 30 seconds. Safety studies were performed in swine (n = 20). In a swine model of ICH, MRgFUS sonothrombolysis of 4 ml ICH was performed. Magnetic resonance imaging and histological examination demonstrated complete lysis of the ICH without additional brain injury, blood-brain barrier breakdown, or thermal necrosis due to sonothrombolysis. A novel cadaveric model of ICH was developed with 40-ml clots implanted into fresh cadaveric brains (n = 10). Intracerebral hemorrhages were successfully liquefied (> 95%) with transcranial MRgFUS in a highly accurate fashion, permitting minimally invasive aspiration of the lysate under MRI guidance. Conclusions The feasibility of transcranial MRgFUS sonothrombolysis was demonstrated in in vitro and cadaveric models of ICH. Initial in vivo safety data in a swine model of ICH suggest the process to be safe. Minimally invasive treatment of ICH with MRgFUS warrants evaluation in the setting of a clinical trial.

Initial Single-Center Technical Experience With the BrainPath System for Acute Intracerebral Hemorrhage Evacuation

2016 ◽  
Vol 13 (1) ◽  
pp. 69-76 ◽  
Author(s):  
Andrew M. Bauer ◽  
Peter A. Rasmussen ◽  
Mark D. Bain
Keyword(s):  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Clinical Outcomes ◽  
Glasgow Coma Score ◽  
Cleveland Clinic ◽  
Interquartile Range ◽  
High Morbidity ◽  
Single Center ◽  
Acute Intracerebral Hemorrhage

Abstract BACKGROUND: Surgical intervention has been proposed as a means of reducing the high morbidity and mortality associated with acute intracerebral hemorrhage (ICH), but many previously reported studies have failed to show a clinically significant benefit. Newer, minimally invasive approaches have shown some promise. OBJECTIVE: We report our early single-center technical experience with minimally invasive clot evacuation using the BrainPath system. METHODS: Prospective data were collected on patients who underwent ICH evacuation with BrainPath at the Cleveland Clinic from August 2013 to May 2015. RESULTS: Eighteen patients underwent BrainPath evacuation of ICH at our center. Mean ICH volume was 52.7 mL ± 22.9 mL, which decreased to 2.2 mL ± 3.6 mL postevacuation, resulting in a mean volume reduction of 95.7% ± 5.8% (range 0-14 mL, P < .001). In 65% of patients, a bleeding source was identified and treated. There were no hemorrhagic recurrences during the hospital stay. In this cohort, only 1 patient (5.6%) died in the first 30 days of follow-up. Median Glasgow Coma Score improved from 10 (interquartile range 5.75-12) preoperation to 14 (interquartile range 9-14.25) postoperation. Clinical follow-up in this cohort is ongoing. CONCLUSION: Evacuation of ICH using the BrainPath system is safe and technically effective. The volume of clot removed compares favorably with other published studies. Early improved clinical outcomes are suggested by improvement in Glasgow Coma Score and reduced 30-day mortality. Ongoing analysis is necessary to elucidate long-term clinical outcomes and the subsets of patients who are most likely to benefit from surgery.

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