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Technical video
Minimally invasive surgiscopic evacuation of intracerebral hemorrhage
  1. Zachary Troiani,
  2. Luis C Ascanio,
  3. Kurt A Yaeger,
  4. Muhammad Ali,
  5. Christopher Paul Kellner
  1. Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  1. Correspondence to Zachary Troiani, Neurosurgery, Icahn School of Medicine at Mount Sinai, New York NY 10029, USA; zachtroiani{at}gmail.com

Abstract

Intracerebral hemorrhage (ICH) is a devastating form of stroke associated with a 40% mortality rate at 30 days and a 75% functional dependence rate at 6 months. The role of surgery to treat ICH remains controversial. Preclinical studies suggest minimally invasive clot evacuation following ICH may benefit patients by mitigating primary and secondary brain injury.1 ,2 In this video, we report the operative technique used in minimally invasive surgicsopic evacuation following ICH (video 1). We demonstrate our presurgical approach using preoperative volumetric imaging loaded onto a stereotactic guidance system. Evacuation of intraparenchymal and intraventricular components of a hemorrhage are shown under direct surgiscopic vision using the Aurora System (Integra LifeSciences, Princeton, NJ, USA). Hemostasis is achieved when actively bleeding vessels are directly cauterized and irrigation of the clot cavity yields no fresh blood. Pre- and postevacuation radiographic differences illustrate the mitigation of clot burden in an elderly patient.

Video 1
  • hemorrhage
  • brain
  • endoscopy

https://doi.org/10.1136/neurintsurg-2020-016553

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    Footnotes

    • Twitter @chriskellnerMD

    • Contributors ZT: acquisition and creation of the video, drafting, revising, and final approval of the video. LAC: drafting, revising, and final approval of the video. KAY: performing the surgical procedure, revising the video, and final approval. MA: drafting, revising, and final approval of the video. CPK: performing the surgical procedure, acquisition of the video, narration, revising, and final approval of the video. All authors acknowledge that they are accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests CPK reports ownership interest in Metis Innovative.

    • Patient consent for publication Not required.

    • Ethics approval This is a technical video report of a single neurosurgical procedure which does not require IRB approval.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on request to the corresponding author.