Clinical Study
Endoport-assisted surgery for the management of spontaneous intracerebral hemorrhage

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Abstract

The aim of this retrospective study is to report our initial experience with endoport-assisted microsurgical evacuation (EAME) of intracerebral hemorrhages (ICH). Neurosurgical intervention has not been shown to significantly improve patient outcomes after spontaneous ICH. Minimally invasive technologies, such as endoport systems, may offer a better risk to benefit profile for ICH evacuation than conventional approaches. We performed a retrospective review of all patients who underwent EAME of ICH from January 2013 to February 2015 using the BrainPath endoport system (NICO, Indianapolis, IN, USA). The baseline and follow-up patient and ICH characteristics were analyzed. Of the 11 patients included for analysis, seven were women (64%), and the median age was 65 years (range: 23–84). The ICH was supratentorial in nine patients (82%), and the median ICH score was 2 (range: 1–4). The median preoperative and postoperative ICH volumes were 51 cm3 (range: 8–168) and 10 cm3 (range: 0.4–59), respectively, with a median reduction in ICH volume of 87% (range: 38–99). The median preoperative and postoperative amounts of midline shift were 6.7 mm (range: 4.9–14.3) and 3.7 mm (range: 2.2–8.9), respectively, with a median reduction in midline shift of 38% (range: 18–61). At the 90 day follow-up, four patients (36%) were functionally independent (modified Rankin Scale 0–2). Four patients had ICH-related mortalities (36%). EAME appears to be a safe and effective treatment option for ICH. Further studies are necessary to assess the comparative effectiveness of EAME in relation to medical therapy or other interventional techniques, for the management of ICH patients.

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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