Minimally Invasive Intracerebral Hematoma Evacuation Using a Novel Cost-Effective Tubular Retractor: Single-Center Experience

We understand only a small fraction of the events happening in our brains; therefore, despite all the progress made thus far, a whole array of questions remains. Nonetheless, neurosurgeons invented new tools to circumvent the challenges that had plagued their predecessors. With the manufacturing boom of the 20th century, technological innovations blossomed enabling the neuroscientific community to study and operate upon the living brain in finer detail and with greater precision while avoiding harm to the nervous system. The purpose of this chronological review is to 1) raise awareness among future neurosurgeons about the latest advances in the field, 2) become familiar with innovations such as augmented reality (AR) that should be included in education given their ready applicability in surgical training, and 3) be comfortable with customizing these technologies to real-life cases like in the case of mixed reality.

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“…Apparently, this creative effort arises from the desire of moving the field forward despite the financial limitations. 92 , 93 )…”

Section: Limitationsmentioning

confidence: 99%

Evolution and Revolution of Imaging Technologies in Neurosurgery

Ogando‐Rivas

Castillo

Beltrán

et al. 2022

Neurol. Med. Chir.(Tokyo)

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“…Spontaneous intracerebral hemorrhage is a common clinical entity, accounting for 10% to 20% of all strokes [1]. Spontaneous intracerebral hemorrhage has high morbidity and mortality, with a 30-day mortality rate of approximately 40% [2]. Beyond the impact on the physiologic and psychological health of survivors, spontaneous intracerebral hemorrhage imposes a substantial burden on families and society.…”

Section: Introductionmentioning

confidence: 99%

Improved Precision and Safety of Supra-Tentorial Intracranial Hematoma Puncture Using C-Arm CT Four-Dimensional Navigation

Zhu,

Zhang,

et al. 2024

Med Sci Monit

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Background Spontaneous intracerebral hemorrhage has a high fatality rate within the initial month after onset. This study determined the safety and therapeutic efficacy of minimally invasive puncture for supra-tentorial intracranial hematoma under C-arm computed tomography (CT) 4-dimensional navigation. Material/Methods We retrospectively analyzed 64 patients with supra-tentorial cerebral hemorrhage from June 2020 to May 2023; 31 patients were assigned to the study group (C-arm CT navigation puncture) and 33 patients were in the control group (conventional CT-guided puncture). The analysis focused on assessment of puncture error, postoperative complication rate, and the Glasgow Outcome Scale (GOS) and National Institute of Health Stroke Scale (NIHSS) scores 30 and 90 days after surgery. Results C-arm CT navigation puncture had improved precision, with significantly reduced transverse (3.17±1.75 mm) and longitudinal (1.83±1.21 mm) deviations, compared with the control group (7.88±1.74 mm and 5.50±1.84 mm, respectively; P <0.05). The overall postoperative complication rate was significantly lower in the study group than in the control group (12.90% vs 36.36%, P <0.05). The mean GOS score was higher in the study group than in the control group 30 and 90 days postoperatively (3.42±0.96 and 3.97±0.95 vs 2.94±0.79 and 3.46±0.90, respectively; P <0.05), while the mean NIHSS score was lower in the study group than in the control group 30 and 90 days postoperatively (10.58±6.52 and 5.97±4.55 vs 14.42±8.13 and 9.55±8.31, respectively; P <0.05). Conclusions Supra-tentorial intracranial hematoma puncture under C-arm CT 4-dimensional navigation is accurate, safe, and beneficial.

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“…However, very few studies have evaluated prognosticators of outcome after endoscopic and endoport-assisted tubular ICH evacuation. 3 The ICH score is a ABBREVIATIONS: AC, anticoagulant; AP, antiplatelet; CTH, computed tomography of the head; Evac, evacuation; HR, hazard ratio; LTACH, long-term acute care hospital; mGraeb, modified Graeb; MIS, minimally invasive surgical; NIHSS, NIH Stroke Scale.…”

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confidence: 99%

“…However, very few studies have evaluated prognosticators of outcome after endoscopic and endoport-assisted tubular ICH evacuation. 3 The ICH score is a commonly used prognostic model to predict 30-day mortality after ICH; however, that model was validated in both medically and surgically managed patients and did not include modern MIS evacuation techniques. 4 An understanding of the predictors of functional outcomes after MIS evacuation using tubular retractor systems may help to better delineate ICH evacuation indications and prognosticate patient outcomes.…”

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confidence: 99%

Prognosticators of Functional Outcome After Supratentorial Minimally Invasive Intracranial Hemorrhage Evacuation With Tubular Retractor Systems

Kashkoush,

El-Abtah,

Achey

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Prognosticators of good functional outcome after minimally invasive surgical (MIS) intracranial hemorrhage (ICH) evacuation are poorly defined. This study aims to investigate clinical and radiographic prognosticators of poor functional outcome after MIS evacuation of ICH with tubular retractor systems. METHODS: Single-center retrospective review of adult (age ≥18 years) patients who underwent surgical evacuation of a spontaneous supratentorial ICH evacuation using tubular retractors from 2013 to 2022 was performed. Clinical and radiographic factors, such as antiplatelet/anticoagulant use, initial NIH Stroke Scale, ICH score, premorbid modified Rankin Scale (mRS), intraventricular hemorrhage (IVH) severity according to the modified Graeb scale, and preoperative/postoperative ICH volume, were collected. The main outcome was poor functional outcome, defined as mRS score of 4–6 within 1 year postoperatively. RESULTS: Eighty-eight patients were included. Clinical follow-up data were available for 64 (73%) patients. Of those, 43 (67%) had a poor functional outcome. On multivariate Cox regression, postoperative ICH volume ≥15 mL (hazard ratio [HR] = 2.46 [95% CI: 1.25-4.87]; P = .010) and higher modified Graeb score (HR = 1.04 [95% CI: 1-1.1]; P = .035] significantly increased the risk of poor functional outcome. Elevated postoperative ICH volume was predicted by the presence of lobar ICH (vs nonlobar, OR = 3.32 [95% CI: 1.01-11.55]; P = .043) and higher preoperative ICH volume (OR = 1.05 [1.02-1.08]; P < .001). A minimum of 60% ICH evacuation yielded an improvement in mRS 4–6 rates (HR 0.3 [95% CI: 0.1-0.8], P = .013). In patients without IVH and with a >80% ICH evacuation, the rate of mRS 4–6 was 42% compared with 67% in the whole patient sample (P = .017). CONCLUSION: Increased IVH volumes and residual postoperative ICH volumes are associated with poor functional outcome after MIS ICH evacuation. Postoperative ICH volume was associated with lobar ICH location as well as preoperative ICH volume. These factors may help to prognosticate patient outcomes and improve selection criteria for MIS ICH evacuation techniques.

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Minimally Invasive Intracerebral Hematoma Evacuation Using a Novel Cost-Effective Tubular Retractor: Single-Center Experience

Cited by 8 publications

References 28 publications

Evolution and Revolution of Imaging Technologies in Neurosurgery

Evolution and Revolution of Imaging Technologies in Neurosurgery

Improved Precision and Safety of Supra-Tentorial Intracranial Hematoma Puncture Using C-Arm CT Four-Dimensional Navigation

Prognosticators of Functional Outcome After Supratentorial Minimally Invasive Intracranial Hemorrhage Evacuation With Tubular Retractor Systems

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