Intraoperative CT and cone-beam CT imaging for minimally invasive evacuation of spontaneous intracerebral hemorrhage

• Published in: Acta neurochirurgica 2020-12, Vol.162 (12), p.3167-3177
• Main Authors: Hecht, Nils, Czabanka, Marcus, Kendlbacher, Paul, Raff, Julia-Helene, Bohner, Georg, Vajkoczy, Peter
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Cerebral Hemorrhage - complications; Cerebral Hemorrhage - diagnostic imaging; Cerebral Hemorrhage - surgery; Computed tomography; Cone-Beam Computed Tomography; Craniotomy - methods; Endoscopy; Endoscopy - methods; Feasibility studies; Female; Hematoma; Hematoma - etiology; Hematoma - surgery; Hemorrhage; Humans; Interventional Radiology; Intraoperative Care; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgery; Minimally Invasive Surgical Procedures; Neurology; Neuroradiology; Neurosurgery; Neurosurgical technique evaluation; Original - Neurosurgical technique evaluation; Original Article - Neurosurgical technique evaluation; Patients; Surgery; Surgical Orthopedics; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-020-04284-y

Background Minimally invasive surgery (MIS) for evacuation of spontaneous intracerebral hemorrhage (ICH) has shown promise but there remains a need for intraoperative performance assessment considering the wide range of evacuation effectiveness. In this feasibility study, we analyzed the benefit of intraoperative 3-dimensional imaging during navigated endoscopy-assisted ICH evacuation by mechanical clot fragmentation and aspiration. Methods 18 patients with superficial or deep supratentorial ICH underwent MIS for clot evacuation followed by intraoperative computerized tomography (iCT) or cone-beam CT (CBCT) imaging. Eligibility for MIS required (a) availability of intraoperative iCT or CBCT, (b) spontaneous lobar or deep ICH without vascular pathology, (c) a stable ICH volume (20–90 ml), (d) a reduced level of consciousness (GCS 5–14), and (e) a premorbid mRS ≤ 1. Demographic, clinical, and radiographic patient data were analyzed by two independent observers. Results Nine female and 9 male patients with a median age of 76 years (42–85) presented with an ICH score of 3 (1–4), GCS of 10 (5–14) and ICH volume of 54 ± 26 ml. Clot fragmentation and aspiration was feasible in all cases and intraoperative imaging determined an overall evacuation rate of 80 ± 19% (residual hematoma volume: 13 ± 17 ml; p