The Safety and Feasibility of Image-Guided BrainPath-Mediated Transsulcul Hematoma Evacuation: A Multicenter Study

Labib, Mohamed A.; Shah, M. Mohsin; Kassam, Amin; Young, Ronald L.; Zucker, Lloyd; Maioriello, Anthony; Britz, Gavin W.; Agbi, Charles; Day, J. D.; Gallia, Gary L.; Kerr, Robert G.; Pradilla, Gustavo; Rovin, Richard; Kulwin, Charles; Bailes, Julian E.

doi:10.1227/neu.0000000000001316

Cited by 152 publications

(93 citation statements)

References 40 publications

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“…These advantages may result in shorter intensive care unit stays, and a reduction in iatrogenic re-hemorrhage rates. Another method of endoscopic hematoma evacuation that involves diffusion tensor imaging technology, the Brain Patch tubular retraction device (a high-definition visualization platform and a specially designed resection device), is being studied and has shown promising results 18. It is designed to avoid excessive damage to white matter tracts while accessing deep lesions 18.…”

Section: Discussionmentioning

confidence: 99%

“…Another method of endoscopic hematoma evacuation that involves diffusion tensor imaging technology, the Brain Patch tubular retraction device (a high-definition visualization platform and a specially designed resection device), is being studied and has shown promising results 18. It is designed to avoid excessive damage to white matter tracts while accessing deep lesions 18. However, the experience with this new device is limited to smaller multicenter series, and large series and randomized trials are needed.…”

Section: Discussionmentioning

confidence: 99%

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Minimally invasive endoscopic hematoma evacuation vs best medical management for spontaneous basal-ganglia intracerebral hemorrhage

Goyal

Tsivgoulis

Malhotra

et al. 2019

J NeuroIntervent Surg

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BackgroundWe conducted a case-control study to assess the relative safety and efficacy of minimally invasive endoscopic surgery (MIS) for clot evacuation in patients with basal-ganglia intracerebral hemorrhage (ICH).MethodsWe evaluated consecutive patients with acute basal-ganglia ICH at a single center over a 42-month period. Patients received either best medical management according to established guidelines (controls) or MIS (cases). The following outcomes were compared before and after propensity-score matching (PSM): in-hospital mortality; discharge National Institutes of Health Stroke Scale score; discharge disposition; and modified Rankin Scale scores at discharge and at 3 months.ResultsAmong 224 ICH patients, 19 (8.5%) underwent MIS (mean age, 50.9±10.9; 26.3% female, median ICH volume, 40 (IQR, 25–51)). The interventional cohort was younger with higher ICH volume and stroke severity compared with the medically managed cohort. After PSM, 18 MIS patients were matched to 54 medically managed individuals. The two cohorts did not differ in any of the baseline characteristics. The median ICH volume at 24 hours was lower in the intervention group (40 cm3 (IQR, 25–50) vs 15 cm3 (IQR, 5–20); P<0.001). The two cohorts did not differ in any of the pre-specified outcomes measures except for in-hospital mortality, which was lower in the interventional cohort (28% vs 56%; P=0.041).ConclusionsMinimally invasive endoscopic hematoma evacuation was associated with lower rates of in-hospital mortality in patients with spontaneous basal-ganglia ICH. These findings support a randomized controlled trial of MIS versus medical management for ICH.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Minimally invasive endoscopic hematoma evacuation vs best medical management for spontaneous basal-ganglia intracerebral hemorrhage

Goyal

Tsivgoulis

Malhotra

et al. 2019

J NeuroIntervent Surg

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“…We used a transsulcal corridor exclusively, primarily a portal-access corridor, for the evacuation of ICHs following a previously reported technique. 8,20 Category II consists of intraaxial lesions, either primary or secondary, not involving eloquent brain areas, and extraaxial lesions that do not involve either the skull base or major venous sinuses. In line with current acceptance, eloquent brain areas were defined as areas in the cerebral hemisphere required for carrying out basic neurological functions (sensorimotor cortex, language cortex, and subcortical structures such as the internal capsule and basal ganglia).…”

Section: Classification Of the Surgical Complexity Levelmentioning

confidence: 99%

Initial experience with a robotically operated video optical telescopic-microscope in cranial neurosurgery: feasibility, safety, and clinical applications

Gonen

Chakravarthi

Monroy-Sosa

et al. 2017

Neurosurgical Focus

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OBJECTIVEThe move toward better, more effective optical visualization in the field of neurosurgery has been a focus of technological innovation. In this study, the authors’ objectives are to describe the feasibility and safety of a new robotic optical platform, namely, the robotically operated video optical telescopic-microscope (ROVOT-m), in cranial microsurgical applications.METHODSA prospective database comprising patients who underwent a cranial procedure between April 2015 and September 2016 was queried, and the first 200 patients who met the inclusion criteria were selected as the cohort for a retrospective chart review. Only adults who underwent microsurgical procedures in which the ROVOT-m was used were considered for the study. Preoperative, intraoperative, and postoperative data were retrieved from electronic medical records. The authors address the feasibility and safety of the ROVOT-m by studying various intraoperative variables and by reporting perioperative morbidity and mortality, respectively. To assess the learning curve, cranial procedures were categorized into 6 progressively increasing complexity groups. The main categories of pathology were I) intracerebral hemorrhages (ICHs); II) intraaxial tumors involving noneloquent regions or noncomplex extraaxial tumors; III) intraaxial tumors involving eloquent regions; IV) skull base pathologies; V) intraventricular lesions; and VI) cerebrovascular lesions. In addition, the entire cohort was evenly divided into early and late cohorts.RESULTSThe patient cohort comprised 104 female (52%) and 96 male (48%) patients with a mean age of 56.7 years. The most common pathological entities encountered were neoplastic lesions (153, 76.5%), followed by ICH (20, 10%). The distribution of cases by complexity categories was 11.5%, 36.5%, 22%, 20%, 3.5%, and 6.5% for Categories I, II, II, IV, V, and VI, respectively. In all 200 cases, the surgical goal was achieved without the need for intraoperative conversion. Overall, the authors encountered 3 (1.5%) major neurological morbidities and 6 (3%) 30-day mortalities. Four of the 6 deaths were in the ICH group, resulting in a 1% mortality rate for the remainder of the cohort when excluding these patients. None of the intraoperative complications were considered to be attributable to the visualization provided by the ROVOT-m. When comparing the early and late cohorts, the authors noticed an increase in the proportion of higher-complexity surgeries (Categories IV–VI), from 23% in the early cohort, to 37% in the late cohort (p = 0.030). In addition, a significant reduction in operating room setup time was demonstrated (p < 0.01).CONCLUSIONSThe feasibility and safety of the ROVOT-m was demonstrated in a wide range of cranial microsurgical applications. The authors report a gradual increase in case complexity over time, representing an incremental acquisition of experience with this technology. A learning curve of both setup and execution phases should be anticipated by new adopters of the robot system. Further prospective studies are required to address the efficacy of ROVOT-m. This system may play a role in neurosurgery as an integrated platform that is applicable to a variety of cranial procedures.

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“…24 One drawback of MRg-HIFU is its inability to lyse clots within 2 cm of the calvaria because of bony attenuation and heat generation; however, these superficial clots are more likely to be amenable to surgical evacuation. 39,61 In addition, technical complexity and time requirements represent limitations to the current application of MRg-HIFU sonolysis in both AIS and ICH. However, we anticipate that these limitations will become obviated with the more widespread use of MRg-HIFU and technological advancements in the future.…”

Section: Potential Applicationsmentioning

confidence: 99%

Magnetic resonance–guided, high-intensity focused ultrasound sonolysis: potential applications for stroke

Ilyas

Chen

Ding

et al. 2018

Neurosurgical Focus

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Stroke is one of the leading causes of death worldwide and a significant source of long-term morbidity. Unfortunately, a substantial number of stroke patients either are ineligible or do not significantly benefit from contemporary medical and interventional therapies. To address this void, investigators recently made technological advances to render transcranial MR-guided, high-intensity focused ultrasound (MRg-HIFU) sonolysis a potential therapeutic option for both acute ischemic stroke (AIS)—as an alternative for patients with emergent large-vessel occlusion (ELVO) who are ineligible for endovascular mechanical thrombectomy (EMT) or as salvage therapy for patients in whom EMT fails—and intracerebral hemorrhage (ICH)—as a neoadjuvant means of clot lysis prior to surgical evacuation. Herein, the authors review the technological principles behind MRg-HIFU sonolysis, its results in in vitro and in vivo stroke models, and its potential clinical applications. As a noninvasive transcranial technique that affords rapid clot lysis, MRg-HIFU thrombolysis may develop into a therapeutic option for patients with AIS or ICH. However, additional studies of transcranial MRg-HIFU are necessary to ascertain the merit of this treatment approach for thrombolysis in both AIS and ICH, as well as its technical limitations and risks.

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The Safety and Feasibility of Image-Guided BrainPath-Mediated Transsulcul Hematoma Evacuation: A Multicenter Study

Abstract: The approach was safely performed in all patients with a relatively high rate of clot evacuation and functional independence.

Cited by 152 publications

References 40 publications

Minimally invasive endoscopic hematoma evacuation vs best medical management for spontaneous basal-ganglia intracerebral hemorrhage

Minimally invasive endoscopic hematoma evacuation vs best medical management for spontaneous basal-ganglia intracerebral hemorrhage

Initial experience with a robotically operated video optical telescopic-microscope in cranial neurosurgery: feasibility, safety, and clinical applications

Magnetic resonance–guided, high-intensity focused ultrasound sonolysis: potential applications for stroke

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