Clinical StudyEndoport-assisted surgery for the management of spontaneous intracerebral hemorrhage
Introduction
Spontaneous intracerebral hemorrhage (ICH) is the etiology of 10–20% of all strokes and remains a significant cause of neurologic morbidity [1], [2]. Unfortunately, interventional therapy has not been shown to significantly improve ICH patient outcomes compared to medical management [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]. Minimally invasive surgery (MIS) may offer a neurosurgical treatment option with a more favorable safety profile than conventional approaches, without compromising efficacy. The endoport is a recent development for the treatment of deep seated intracranial lesions [13], [14]. This device allows for smaller skin incisions, craniotomies, and dural openings, and causes less violation of the cortex and disturbance of the subcortical white matter fiber tracts compared to traditional transcortical approaches for ICH surgery [15], [16]. The aim of this retrospective cohort study is to describe the surgical technique and postoperative outcomes for endoport-assisted microsurgical evacuation (EAME) of ICH.
Section snippets
Patient selection and outcome measures
We retrospectively reviewed the medical records of all patients who underwent EAME of ICH from January 2013, when we first began using endoport technology, to February 2015. For each patient, ICH was diagnosed at the time of presentation with a non-contrast brain CT scan. Dedicated neurovascular imaging (CT angiography and/or digital subtraction catheter angiography) was used to rule out an underlying vascular lesion for all ICH patients. All neuroimaging was independently reviewed by a
Patient and ICH characteristics
A total of 11 patients comprised the cohort for this study. The baseline patient and ICH characteristics, and radiographic and clinical outcomes are summarized in Table 1. There were seven women (64%) and four men (36%), with a median age of 65 years (range: 23–84). Six patients (55%) had a history of hypertension, and one patient (9%) had a history of atrial fibrillation. Three patients were taking warfarin (27%) and six patients were taking aspirin (55%), two of whom were taking both
Discussion
ICH is a common and disabling disease, but surgery has not been conclusively shown to improve patient outcomes. The results of comparisons between the surgical and medical management of ICH have been negative or inconclusive, therefore, the role of neurosurgical intervention in the management of ICH remains controversial. The use of minimally invasive endoport systems for ICH evacuation may improve surgical outcomes compared to traditional transcortical approaches. The main findings from this
Conclusion
EAME appears to be a safe and effective interventional treatment option for patients with spontaneous ICH. The use of an endoport for ICH evacuation has unique advantages over both conventional and minimally invasive neurosurgical approaches. However, larger prospective studies are needed to determine if EAME of ICH affords a benefit in mortality or functional outcomes compared to medical management, conventional cranial surgery, and other forms of MIS.
Conflicts of Interest/Disclosures
The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.
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2021, World NeurosurgeryCitation Excerpt :Recently reported results of ICH evacuation using commercial tubular retractors have shown encouraging outcomes for patients with this morbid disease. Przybylowski et al.31 reported on 9 patients with supratentorial ICH who underwent surgical evacuation using a Brainpath retractor and a bimanual microscopic technique. Mean hematoma volume reduction was 76%, postoperative complications were noted in 2 patients (22%), and 3 patients (33%) died after surgery.
Use of 11 mm BrainPath endoport in minimally invasive hematoma evacuation: A case report
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2021, World NeurosurgeryCitation Excerpt :Furthering this concept, Chen et al.33 used MIPS in the setting of traumatic brain injury, and reported an average Glasgow Outcome Scale score improvement of 4 in 6 patients. Przybylowski et al.34 reported reasonable outcome in 11 patients, with 36% of the patients achieving a postoperative mRS score of 0–2 and 4 deaths directly caused by ICH. Bauer et al.32 in 18 patients reported successful outcome with MIPS, with a median GCS score of 14 (interquartile range, 9–14.25), a mean clot volume reduction of 95.7%, and 1 mortality caused by ICH-related complications.