minimally-invasive-endoscopic-intracerebral-hemorrhage-evacuation

Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation

Intracerebral hemorrhage (ICH) is a subtype of stroke with high mortality and poor functional outcomes, largely because there are no evidence-based ...

Icahn School of Medicine at Mount Sinai

Endoscopic intracerebral hemorrhage (ICH) evacuation techniques have gained interest as a potential therapeutic option. However, the instrumentation and techniques employed are still being refined to optimize hemostasis and evacuation efficiency.

The Stereotactic Intracerebral Hemorrhage Underwater Blood Aspiration (SCUBA) technique for minimally invasive endoscopic intracerebral hemorrhage evacuation.

Spontaneous cerebellar intracerebral hemorrhage (scICH) constitutes ∼10% of all cases of spontaneous ICH, with a mortality of 20%-50%. Suboccipital craniectomy (SOC) is commonly performed for scICH causing brainstem compression or hydrocephalus. However, SOC requires long anesthesia times and results in a high complication rate. We present a series of patients who minimally invasive scICH evacuation as an alternative to traditional SOC.

Minimally Invasive Evacuation of Spontaneous Cerebellar Intracerebral Hemorrhage.

Background and Purpose- Minimally invasive surgery (MIS) for intracerebral hemorrhage (ICH) has been evaluated in numerous clinical trials. Although meta-analyses for this strategy have been performed in the past, recent trials add important information to results of the comparison and permit strategy-specific analyses, including evaluation of endoscopic evacuation and stereotactic thrombolysis. Methods- Major scientific databases including but not limited to Pubmed, the CENTRAL (Cochrane Central Register of Controlled Trials), Embase, Web of Science, Scopus, the ICTRP (International Clinical Trials Registry Platform), the Internet Stroke Center, and the CNKI (Chinese National Knowledge Infrastructure) were searched in October of 2017 for randomized controlled trials of MIS treatment of supratentorial spontaneous ICH. The primary outcome was defined as death or dependence at the end of follow-up, and the secondary outcome was defined as death. Results- The initial search yielded 958 reports, which were reduced to 15 high-quality randomized controlled trials involving 2152 patients. We analyzed odds ratios for MIS overall, endoscopic surgery, and stereotactic thrombolysis compared with conventional treatment, including medical treatment and conventional craniotomy. The odds ratio and CIs of the primary and secondary outcomes were 0.46 (0.36-0.57) and 0.59 (0.45-0.76) for MIS versus conventional treatment; 0.40 (0.25-0.66) and 0.37 (0.20-0.67) for endoscopic surgery versus conventional treatment; 0.47 (0.34-0.65) and 0.76 (0.56-1.04) for stereotactic thrombolysis versus conventional treatment; and 0.44 (0.29-0.67) and 0.56 (0.37-0.84) for MIS versus craniotomy. We also conducted subgroup analyses focusing on time to evacuation for MIS versus conventional treatment and found 0.36 (0.22-0.59) and 0.59 (0.34-1.00) for evacuations performed within 24 hours and 0.49 (0.38-0.63) and 0.57 (0.43-0.76) for evacuations performed within 72 hours. Conclusions- This meta-analysis demonstrates that select patients with supratentorial ICH benefit from MIS over other treatments. This beneficial effect remains true when analyzing specific techniques and evacuation timing subgroups.

Minimally Invasive Surgery for Intracerebral Hemorrhage.

Minimally invasive intracerebral hemorrhage (ICH) evacuation has gained popularity with success in early-phase clinical trials. This procedure, however, is performed in very different ways around the world.

A Compendium of Modern Minimally Invasive Intracerebral Hemorrhage Evacuation Techniques.

Endovascular therapy (EVT) has emerged as the standard of care for emergent large vessel occlusion (ELVO) acute ischemic stroke. An increasing number of patients with suspected ELVO are being transferred to stroke centers with interventional capacity. Not all such inter-hospital transfers result in EVT.

Major Causes for Not Performing Endovascular Therapy Following Inter-Hospital Transfer in a Complex Urban Setting.

Preclinical studies suggest that clot removal may mitigate primary and secondary brain injury following intracerebral hemorrhage (ICH). Although the MISTIE trial did not demonstrate an overall outcome benefit, it did demonstrate outcome benefit from effective reduction of clot burden. Minimally invasive endoscopic ICH evacuation may provide an alternative option for clot evacuation.

Long-term functional outcome following minimally invasive endoscopic intracerebral hemorrhage evacuation.

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.

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

Intracerebral hemorrhage (ICH) is the most devastating form of stroke, with thalamic hemorrhages carrying the worst outcomes. Minimally invasive (MIS) endoscopic ICH evacuation is a promising new therapy for the condition. However, it remains unclear whether therapy success is location dependent. Here we present long-term functional outcomes after MIS evacuation of spontaneous thalamic hemorrhages.

Functional Outcome After Minimally Invasive Endoscopic Evacuation of Thalamic Intracerebral Hemorrhage.

Perihematomal edema (PHE) volume correlates with intracerebral hemorrhage (ICH) volume and is associated with functional outcome. Minimally invasive surgery (MIS) for ICH decreases clot burden and PHE. MIS may therefore alter the time course of PHE, mitigating a critical source of secondary injury.

Article	Year
The Stereotactic Intracerebral Hemorrhage Underwater Blood Aspiration (SCUBA) technique for minimally invasive endoscopic intracerebral hemorrhage evacuation. Journal of neurointerventional surgery\| PubMed ID: 29572265	2018
Minimally Invasive Evacuation of Spontaneous Cerebellar Intracerebral Hemorrhage. World neurosurgery\| PubMed ID: 30292039	2019
Minimally Invasive Surgery for Intracerebral Hemorrhage. Stroke\| PubMed ID: 30355183	2018
A Compendium of Modern Minimally Invasive Intracerebral Hemorrhage Evacuation Techniques. Operative neurosurgery (Hagerstown, Md.)\| PubMed ID: 31625580	2020
Major Causes for Not Performing Endovascular Therapy Following Inter-Hospital Transfer in a Complex Urban Setting. Cerebrovascular diseases (Basel, Switzerland)\| PubMed ID: 31665728	2019
Long-term functional outcome following minimally invasive endoscopic intracerebral hemorrhage evacuation. Journal of neurointerventional surgery\| PubMed ID: 31915207	2020
Advanced Techniques for Endoscopic Intracerebral Hemorrhage Evacuation: A Technical Report With Case Examples. Operative neurosurgery (Hagerstown, Md.)\| PubMed ID: 32322895	2020
Functional Outcome After Minimally Invasive Endoscopic Evacuation of Thalamic Intracerebral Hemorrhage. World neurosurgery\| PubMed ID: 33548529	2021
Definition and time course of pericavity edema after minimally invasive endoscopic intracerebral hemorrhage evacuation. Journal of neurointerventional surgery\| PubMed ID: 33722960	2021

Jacopo Scaggiante

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