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Huang Z, Alkhars H, Gunderman A, Sigounas D, Cleary K, Chen Y. Optimal Concentric Tube Robot Design for Safe Intracerebral Hemorrhage Removal. JOURNAL OF MECHANISMS AND ROBOTICS 2024; 16:081005. [PMID: 38434486 PMCID: PMC10906783 DOI: 10.1115/1.4063979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Purpose The purpose of this paper is to investigate the geometrical design and path planning of Concentric tube robots (CTR) for intracerebral hemorrhage (ICH) evacuation, with a focus on minimizing the risk of damaging white matter tracts and cerebral arteries. Methods To achieve our objective, we propose a parametrization method describing a general class of CTR geometric designs. We present mathematical models that describe the CTR design constraints and provide the calculation of a path risk value. We then use a genetic algorithm to determine the optimal tube geometry for targeting within the brain. Results Our results show that a multi-tube CTR design can significantly reduce the risk of damaging critical brain structures compared to the conventional straight tube design. However, there is no significant relationship between the path risk value and the number and shape of the additional inner curved tubes. Conclusion Considering the challenges of CTR hardware design, fabrication, and control, we conclude that the most practical geometry for a CTR path in ICH treatment is a straight outer tube followed by a planar curved inner tube. These findings have important implications for the development of safe and effective CTRs for ICH evacuation by enabling dexterous manipulation to minimize damage to critical brain structures.
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Affiliation(s)
- Zhefeng Huang
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Hussain Alkhars
- George Washington University School of Medicine, Washington, DC, USA
| | - Anthony Gunderman
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Dimitri Sigounas
- George Washington University School of Medicine, Washington, DC, USA
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington, DC, USA
| | - Yue Chen
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
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Xu X, Zhang H, Zhang J, Luo M, Wang Q, Zhao Y, Gan Z, Xu B, Chen X. Minimally invasive surgeries for spontaneous hypertensive intracerebral hemorrhage (MISICH): a multicenter randomized controlled trial. BMC Med 2024; 22:244. [PMID: 38867192 PMCID: PMC11170771 DOI: 10.1186/s12916-024-03468-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) is a common stroke type with high morbidity and mortality. There are mainly three surgical methods for treating ICH. Unfortunately, thus far, no specific surgical method has been proven to be the most effective. We carried out this study to investigate whether minimally invasive surgeries with endoscopic surgery or stereotactic aspiration (frameless navigated aspiration) will improve functional outcomes in patients with supratentorial ICH compared with small-bone flap craniotomy. METHODS In this parallel-group multicenter randomized controlled trial conducted at 16 centers, patients with supratentorial hypertensive ICH were randomized to receive endoscopic surgery, stereotactic aspiration, or craniotomy at a 1:1:1 ratio from July 2016 to June 2022. The follow-up duration was 6 months. Patients were randomized to receive endoscopic evacuation, stereotactic aspiration, or small-bone flap craniotomy. The primary outcome was favorable functional outcome, defined as the proportion of patients who achieved a modified Rankin scale (mRS) score of 0-2 at the 6-month follow-up. RESULTS A total of 733 patients were randomly allocated to three groups: 243 to the endoscopy group, 247 to the aspiration group, and 243 to the craniotomy group. Finally, 721 patients (239 in the endoscopy group, 246 in the aspiration group, and 236 in the craniotomy group) received treatment and were included in the intention-to-treat analysis. Primary efficacy analysis revealed that 73 of 219 (33.3%) in the endoscopy group, 72 of 220 (32.7%) in the aspiration group, and 47 of 212 (22.2%) in the craniotomy group achieved favorable functional outcome at the 6-month follow-up (P = .017). We got similar results in subgroup analysis of deep hemorrhages, while in lobar hemorrhages the prognostic outcome was similar among three groups. Old age, deep hematoma location, large hematoma volume, low preoperative GCS score, craniotomy, and intracranial infection were associated with greater odds of unfavorable outcomes. The mean hospitalization expenses were ¥92,420 in the endoscopy group, ¥77,351 in the aspiration group, and ¥100,947 in the craniotomy group (P = .000). CONCLUSIONS Compared with small bone flap craniotomy, endoscopic surgery and stereotactic aspiration improved the long-term outcome of hypertensive ICH, especially deep hemorrhages. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02811614.
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Affiliation(s)
- Xinghua Xu
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Huaping Zhang
- Department of Neurosurgery, Jingzhou Central Hospital, Hubei, China
| | - Jiashu Zhang
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Ming Luo
- Department of Neurosurgery, Wuhan No.1 Hospital, Hubei, China
| | - Qun Wang
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yining Zhao
- Department of Neurosurgery, Erlangen-Nuernberg University Hospital, Erlangen, Germany
| | - Zhichao Gan
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Bainan Xu
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xiaolei Chen
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Monteiro GDA, Marinheiro G, Mutarelli A, Araújo B, Cavalcante-Neto JF, Batista S, Leal PRL, Cristino-Filho G, Figueiredo EG, Telles JPM. Efficacy and safety of neuroendoscopy surgery versus craniotomy for supratentorial intracerebral hemorrhage: an updated meta-analysis of randomized controlled trials. Neurosurg Rev 2024; 47:255. [PMID: 38833192 DOI: 10.1007/s10143-024-02492-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/15/2024] [Accepted: 05/25/2024] [Indexed: 06/06/2024]
Abstract
Neuroendoscopy (NE) surgery emerged as a promising technique for the treatment of spontaneous intracerebral hemorrhage (ICH). A previous meta-analysis of randomized controlled trials (RCTs) analyzed the efficacy and safety of NE compared to craniotomy, but NE did not present a significant improvement in functional outcomes. However, a new study provided an opportunity to update the current knowledge. We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials for RCTs reporting NE evacuation of spontaneous supratentorial ICH compared to craniotomy. The efficacy outcomes of interest were favorable functional outcome, functional disability, hematoma evacuation rate, and residual hematoma volume. The safety outcomes of interest were rebleeding, infection, and mortality. Seven RCTs were included containing 879 patients. The NE approach presented a significantly higher rate of favorable functional outcome compared with craniotomy (RR: 1.42; 95% CI 1.17, 1.73; p < 0.001). The evacuation rate was higher in patients who underwent the NE approach (MD: -8.36; 95% CI -12.66, -4.07; p < 0.001). NE did not show a benefit in improving the mortality rate (RR: 0.81, 95% CI 0.54, 1.22; p = 0.32). NE was associated with more favorable functional outcomes and lower rates of functional disabilities compared to craniotomy. Also, NE was superior regarding evacuation rate, while presenting a reduction in residual hematoma volume. NE might be associated with lower infection rates. Mortality was not improved by NE surgery. Larger, higher-quality randomized studies are needed to adequately evaluate the efficacy and safety of NE compared to craniotomy.
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Affiliation(s)
- Gabriel de Almeida Monteiro
- Department of Neurosurgery, Federal University of Ceará, Av. Cmte. Maurocélio Rocha Pontes, 100 - Jocely Dantas de Andrade Torres, Sobral - CE, Sobral, 62042-250, Brazil.
| | | | - Antonio Mutarelli
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Beatriz Araújo
- Department of Medicine, Nove de Julho University, São Bernado do Campo, Brazil
| | - Joaquim Francisco Cavalcante-Neto
- Department of Neurosurgery, Federal University of Ceará, Av. Cmte. Maurocélio Rocha Pontes, 100 - Jocely Dantas de Andrade Torres, Sobral - CE, Sobral, 62042-250, Brazil
- Department of Neurosurgery, Hospital do Servidor Público Estadual, IAMSPE, São Paulo, Brazil
| | - Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paulo Roberto Lacerda Leal
- Department of Neurosurgery, Federal University of Ceará, Av. Cmte. Maurocélio Rocha Pontes, 100 - Jocely Dantas de Andrade Torres, Sobral - CE, Sobral, 62042-250, Brazil
| | - Gerardo Cristino-Filho
- Department of Neurosurgery, Federal University of Ceará, Av. Cmte. Maurocélio Rocha Pontes, 100 - Jocely Dantas de Andrade Torres, Sobral - CE, Sobral, 62042-250, Brazil
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Wang A, Sun Z, Zhang W, He H, Wang F. Efficacy and Safety of Endoscopic Surgery Versus Craniotomy for Hypertensive Putamen Hemorrhage. J Craniofac Surg 2024; 35:1181-1185. [PMID: 38595184 DOI: 10.1097/scs.0000000000010105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 01/24/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVE This study aimed to evaluate the efficacy and safety of neuroendoscopy for treating hypertensive putamen hemorrhage (HPH), compared with traditional craniotomy. METHODS We retrospectively analyzed 81 consecutive patients with HPH treated with neuroendoscopy (n=36) or craniotomy (n=45) in the Department of Neurosurgery at the Anhui Provincial Hospital Affiliated to Anhui Medical University between January 2015 and December 2017. We compared the clinical and radiographic outcomes, excluded 14 patients who did not meet the inclusion criteria. Patient characteristics in emergency room were recorded. In addition, hospitalization days, total cost during hospitalization, operative time, blood loss, evacuation rate, rebreeding, intracranial infection, pulmonary infection, epilepsy, hemorrhage of digestive tract, venous thrombus, hypoproteinemia, aphasia, oculomotor paralysis, mortality, Modified Rankin Scale score 6 months after surgery, and Glasgow Outcome Scale score 6 months after surgery were compared between the 2 groups. RESULTS Comparative analysis of preoperative patient data revealed no notable disparities. Neuroendoscopic surgery afford distinct benefits including reduced operative time, minimal patient blood loss, and enhanced efficacy in hematoma evacuation. However, the incidence of postoperative complications such as rebleeding, intracranial infections, pulmonary infections, postoperative epilepsy, hemorrhage of digestive tract, venous thrombus, hypoproteinemia, aphasia, and oculomotor paralysis did not significantly differ. In contrast, endoscopic techniques, relative to conventional craniotomy for hematoma evacuation, are characterized by less invasive incisions, a marked decrease in the duration of hospitalization, and a substantial reduction in associated healthcare costs. Furthermore, endoscopic techniques contribute to superior long-term recuperative outcomes in patients, without altering mortality rates. CONCLUSIONS In comparison to the conventional method of craniotomy, the utilization of neuroendoscopy in the treatment of hypertensive putamen hemorrhage (HPH) may offer a more efficacious, minimally invasive, and cost-effective approach. This alternative approach has the potential to decrease the length of hospital stays and improve long-term neurologic outcomes, without altering mortality rates.
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Affiliation(s)
- Anshuo Wang
- Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
- Department of Neurosurgery, Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China
| | - Zikang Sun
- Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
- Department of Neurosurgery, Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China
| | - Wen Zhang
- Department of Neurosurgery, Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China
| | - Hu He
- Department of Neurosurgery, Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China
| | - Fei Wang
- Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
- Department of Neurosurgery, Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China
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Serra R, Chryssikos T. Decompressive craniectomy incisions: all roads lead to bone. Br J Neurosurg 2024:1-8. [PMID: 38651499 DOI: 10.1080/02688697.2024.2344759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/14/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Decompressive craniectomy and craniotomy are among the most common procedures in Neurosurgery. In recent years, increased attention has focused on the relationships between incision type, extent of decompression, vascular supply to the scalp, cosmetic outcomes, and complications. Here, we review the current literature on scalp incisions for large unilateral front-temporo-parietal craniotomies and craniectomies. METHODS Publications in the past 50 years on scalp incisions used for front-temporo-parietal craniectomies/craniotomies were reviewed. Only full texts were considered in the final analysis. A total of 27 studies that met the criteria were considered for the final manuscript. PRISMA guidelines were adopted for this study. RESULTS Five main incision types have been described. In addition to the question mark incision, other common incisions include the T-Kempe, developed to obtain wide access to the skull, the retroauricular incision, designed to spare the occipital branch, as well as the N-shaped and cloverleaf incisions which integrate with pterional approaches. Advantages and drawbacks, integration with existing incisions, relationships with the main arteries, cosmetic outcomes, and risks of wound complications including dehiscence, necrosis, and infection were assessed. DISCUSSION The reverse-question mark incision, despite being a mainstay of trauma neurosurgery, can place the vascular supply to the scalp at risk and favor wound dehiscence and infection. Several incisions, such as the T-Kempe, retroauricular, N-shaped, and cloverleaf approaches have been developed to preserve the main vessels supplying the scalp. Incision choice needs to be carefully weighted based on the patient's anatomy, position and size of main vessels, risk of wound dehiscence, and desired volume of decompression.
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Affiliation(s)
- Riccardo Serra
- Department of Neurosurgery, University of Maryland, Baltimore, MD, USA
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Mendelow AD. New Hope for Adults with Lobar Intracerebral Hemorrhage. N Engl J Med 2024; 390:1328-1329. [PMID: 38598801 DOI: 10.1056/nejme2401643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- A David Mendelow
- From the Neurosurgical Trials Group, Newcastle University, Newcastle upon Tyne, United Kingdom
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Tahara S, Hattori Y, Aso S, Uda K, Kumazawa R, Matsui H, Fushimi K, Yasunaga H, Morita A. Endoscopic surgery versus craniotomy for spontaneous intracerebral hemorrhage in the late elderly patients. J Stroke Cerebrovasc Dis 2023; 32:107327. [PMID: 37677895 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/22/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVES To compare the prognosis of late elderly patients with spontaneous intracerebral hemorrhage (ICH) treated by endoscopic evacuation and craniotomy MATERIALS AND METHODS: Using the Diagnosis Procedure Combination database, we identified patients aged ≥ 75 years who underwent surgery for spontaneous ICH within 48 hours after admission between April 2014 and March 2018. Eligible patients were classified into two groups according to the type of surgery (endoscopic surgery and craniotomy). Propensity-score matching weight analysis was conducted to compare the good neurological outcome modified Rankin Scale (mRS) score (0-4) at discharge as the primary endpoint between the two groups. Secondary endpoints were postoperative meningitis, tracheostomy, reoperation within 3 days and total hospitalization costs. RESULTS Among the 5,396 eligible patients, endoscopic surgery and craniotomy were performed in 895 and 4,501 patients, respectively. In the propensity-score matching weight analysis, all covariates were well balanced. The proportions of patients with a good prognosis (mRS score at discharge: 0-4) did not significantly differ between the surgical procedures (42.1% vs. 42.8%, p = 0.828). The proportions of meningitis, tracheostomy and reoperation were not significantly different between the two groups. Hospitalization costs were significantly higher in the craniotomy group than in the endoscopic surgery group (25,536 vs. 29,603 US dollars, p = 0.012). CONCLUSIONS Inhospital outcomes did not differ between endoscopic and open surgeries for spontaneous ICH in the late-stage elderly patients aged ≥75 years. Hospitalization costs were significantly higher in the craniotomy group, suggesting that endoscopic surgery may be more acceptable.
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Affiliation(s)
- Shigeyuki Tahara
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Yujiro Hattori
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Shotaro Aso
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Kazuaki Uda
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan.
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Akio Morita
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
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Kollmar R, De Georgia M. Milestones in the history of neurocritical care. Neurol Res Pract 2023; 5:43. [PMID: 37559106 PMCID: PMC10413505 DOI: 10.1186/s42466-023-00271-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/24/2023] [Indexed: 08/11/2023] Open
Abstract
Over the last century, significant milestones have been achieved in managing critical illness and diagnosing and treating neurological diseases. Building upon these milestones, the field of neurocritical care emerged in the 1980 and 1990 s at the convergence of critical care medicine and acute neurological treatment. This comprehensive review presents a historical account of key developments in neurocritical care in both the United States and Europe, with a special emphasis on German contributions. The scope of the review encompasses: the foundations of neurocritical care, including post-operative units in the 1920s and 30s, respiratory support during the poliomyelitis epidemics in the 40 and 50 s, cardiac and hemodynamic care in the 60 and 70 s, and stroke units in the 80 and 90 s; key innovations including cerebral angiography, computed tomography, and intracranial pressure and multi-modal monitoring; and advances in stroke, traumatic brain injury, cardiac arrest, neuromuscular disorders, meningitis and encephalitis. These advances have revolutionized the management of neurological emergencies, emphasizing interdisciplinary teamwork, evidence-based protocols, and personalized approaches to care.
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Affiliation(s)
- Rainer Kollmar
- Department of Neurology and Neurointensive Care, Darmstadt Academic Hospital, Darmstadt, Germany.
| | - Michael De Georgia
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Noiphithak R, Yindeedej V, Ratanavinitkul W, Duangprasert G, Nimmannitya P, Yodwisithsak P. Treatment outcomes between endoscopic surgery and conventional craniotomy for spontaneous supratentorial intracerebral hemorrhage: a randomized controlled trial. Neurosurg Rev 2023; 46:136. [PMID: 37278839 DOI: 10.1007/s10143-023-02035-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/24/2023] [Accepted: 05/18/2023] [Indexed: 06/07/2023]
Abstract
Minimally invasive surgery (MIS) has been repeatedly evaluated in patients with ICH as a promising procedure for improved survival and functional outcome. Among MIS techniques, endoscopic surgery (ES) has shown superior efficacy for ICH removal due to rapid clot evacuation and immediate bleeding control. However, the results of ES are still uncertain due to insufficient data. In this study, participants with spontaneous supratentorial ICH who were indicated for surgery were randomly assigned (1:1) to undergo ES or conventional craniotomy (CC) between March 2019 and June 2022. The primary outcome was a difference in favorable modified Rankin Scale (mRS) outcome (0 to 3) at 180-day follow-up evaluated by blind assessors. There were 188 participants, 95 in the ES group and 93 in the CC group, who completed the trial. At 180-day follow-up, 46 (48.4%) participants in the ES group achieved favorable outcomes, compared to 33 (35.5%) in the CC group (risk difference [RD] 12.9, 95% CI - 1.1-27.0, p = 0.07). After covariate adjustment, the difference was slightly higher and significant (adjusted RD 17.3, 95% CI [4.6-30.0], p = 0.01). Moreover, the ES group had less operative duration and less intraoperative blood loss than the CC group. Clot evacuation rate and complications were similar between the two groups. Subgroup analyses showed a potential benefit of ES in age < 60 years, time to surgery ≥ 6 h, and deep ICH. This study showed that ES was safe and effective in ICH removal and provided a better functional outcome compared to CC.
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Affiliation(s)
- Raywat Noiphithak
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand.
| | - Vich Yindeedej
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand
| | - Warot Ratanavinitkul
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand
| | - Gahn Duangprasert
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand
| | - Pree Nimmannitya
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand
| | - Pornchai Yodwisithsak
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand
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Watanabe G, Conching A, Ogasawara C, Chavda V, Bin-Alamer O, Haider AS, Priola SM, Sharma M, Hoz SS, Chaurasia B, Umana GE, Palmisciano P. Bilateral basal ganglia hemorrhage: a systematic review of etiologies, management strategies, and clinical outcomes. Neurosurg Rev 2023; 46:135. [PMID: 37273079 PMCID: PMC10240133 DOI: 10.1007/s10143-023-02044-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/06/2023] [Accepted: 05/27/2023] [Indexed: 06/06/2023]
Abstract
Bilateral basal ganglia hemorrhages (BBGHs) represent rare accidents, with no clear standard of care currently defined. We reviewed the literature on BBGHs and analyzed the available conservative and surgical strategies. PubMed, Scopus, Web of Science, and Cochrane were searched following the PRISMA guidelines to include studies reporting patients with BBGHs. Clinical characteristics, management, and outcomes were analyzed. We included 64 studies comprising 75 patients, 25 (33%) traumatic and 50 (67%) non-traumatic. Traumatic cases affected younger patients (mean age 35 vs. 46 years, p=0.014) and males (84% vs. 71%, p=0.27) and were characterized by higher proportion of normal blood pressures at admission (66% vs. 13%, p=0.0016) compared to non-traumatic cases. Most patients were comatose at admission (56%), with a mean Glasgow Coma Scale (GCS) score of 7 and a higher proportion of comatose patients in the traumatic than in the non-traumatic group (64% vs. 52%, p=0.28). Among the traumatic group, motor vehicle accidents and falls accounted for 79% of cases. In the non-traumatic group, hemorrhage was most associated with hypertensive or ischemic (54%) and chemical (28%) etiologies. Management was predominantly conservative (83%). Outcomes were poor in 56% of patients with mean follow-up of 8 months. Good recovery was significantly higher in the traumatic than in the non-traumatic group (48% vs. 17%, p=0.019). BBGHs are rare occurrences with dismal prognoses. Standard management follows that of current intracerebral hemorrhage guidelines with supportive care and early blood pressure management. Minimally invasive surgery is promising, though substantial evidence is required to outweigh the potentially increased risks of bilateral hematoma evacuation.
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Affiliation(s)
- Gina Watanabe
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Andie Conching
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Christian Ogasawara
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Vishal Chavda
- Department of Pathology, Stanford of School of Medicine, Stanford University Medical Centre, Stanford, Palo Alto, CA, USA
| | - Othman Bin-Alamer
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburg, PA, USA
| | - Ali S Haider
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Stefano M Priola
- Department of Neurosurgery, Health Sciences North, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Mayur Sharma
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Samer S Hoz
- Department of Neurosurgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45229, USA
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| | - Giuseppe E Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45229, USA.
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Tahara S, Hattori Y, Aso S, Uda K, Kumazawa R, Matsui H, Fushimi K, Yasunaga H, Morita A. Outcomes After Endoscopic Evacuation Versus Evacuation Using Craniotomy or Stereotactic Aspiration for Spontaneous Intracerebral Hemorrhage: Analysis Using a Japanese Nationwide Database. Neurocrit Care 2023; 38:667-675. [PMID: 36348138 DOI: 10.1007/s12028-022-01634-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Various surgical methods are available for managing large intracerebral hemorrhage. This study compared the prognosis of patients with spontaneous intracerebral hemorrhage who underwent endoscopic evacuation, stereotactic aspiration, and craniotomy by using a nationwide inpatient database in Japan. METHODS Using the Diagnosis Procedure Combination database, we identified patients who underwent surgery for spontaneous intracerebral hemorrhage within 48 h after admission between April 2014 and March 2018. Eligible patients were classified into three groups according to the type of surgery (endoscopic surgery, stereotactic surgery, and craniotomy). Propensity score matching weight analysis was conducted to compare poor modified Rankin Scale score at discharge (severe disability or death) and hospitalization cost among the groups. RESULTS Among 17,860 eligible patients, craniotomy, stereotactic surgery, and endoscopic surgery were performed in 14,354, 474, and 3,032 patients, respectively. In the matching weight analysis, all covariates were well balanced. Compared with the endoscopic surgery group, the proportion of poor prognosis (modified Rankin Scale score at discharge of 5 or 6) was significantly higher in craniotomy groups (odds ratio 2.51, 95% confidence interval 1.11-5.68; p = 0.028). Subgroup analysis based on hemorrhage location and consciousness level at the time of admission showed no significant difference between the surgical procedures. Hospitalization costs were significantly higher in the craniotomy group than in the endoscopic surgery group (difference US $9,724, 95% confidence interval 2,169-17,259; p = 0.011). CONCLUSIONS Endoscopic surgery for spontaneous intracerebral hemorrhage was associated with improved prognosis compared with craniotomy at the hospital discharge. Future large-scale clinical trials are needed to evaluate the optimal surgical techniques for intracerebral hemorrhage.
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Affiliation(s)
- Shigeyuki Tahara
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Yujiro Hattori
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
- Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Shotaro Aso
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Kazuaki Uda
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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Yudkoff CJ, Rossitto CP, Kellner CP. Minimally invasive intracerebral hemorrhage evacuation: A bibliometric analysis of current research trends. Clin Neurol Neurosurg 2023; 227:107672. [PMID: 36934634 DOI: 10.1016/j.clineuro.2023.107672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/11/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE Intracerebral hemorrhage (ICH) is associated with significant morbidity and mortality. Randomized clinical trials focusing on minimally invasive surgery (MIS) for ICH evacuation have suggested a potential benefit regarding mortality but results remain unclear regarding impact on functional outcome. This study presents a bibliometric analysis investigating the current trends in the literature on MIS for ICH. METHODS Using the Scopus collection database, a search was performed to identify literature that discussed MIS for ICH from 2000 to 2021. Primary research articles were included in this study. Reviews and book chapters were excluded. Analysis and visualization of the included literature were completed with VOSviewer. RESULTS A total of 278 articles were identified. An upward trend in publications began in 2008, with the most publications in 2021 (36) followed by 2020 (25). The most citations occurred in 2013 (1192). The h-index, i-10 and i-100 were 37, 79 and 6 respectively. For the top 100 most cited studies, the mean citation count was 45.55 with a range of 6-760. The highest-producing institutions of MIS for ICH literature were Johns Hopkins University (31, 15 %), University of Chicago with (21, 10 %), Guiyang Medical College (17, 8 %), and Icahn School of Medicine at Mount Sinai (15, 7 %). Keyword analysis revealed four major avenues: 1) medication enhancement of clot removal, 2) minimally invasive devices such as endoscopes, 3) craniotomy approach, and 4) physiology of clot removal. CONCLUSIONS The literature on MIS for ICH has been expanding since 2008. Key topics include thrombolysis, device innovation, and surgical approach.
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Affiliation(s)
- Clifford J Yudkoff
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
| | - Christina P Rossitto
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher P Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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13
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Fang Y, Wang J, Chen L, Yan W, Gao S, Liu Y, Wang X, Dong X, Zhang J, Chen S, Liu F, Wang Z, Zhang Y. Functional Outcome Analysis of Stereotactic Catheter Aspiration for Spontaneous Intracerebral Hemorrhage: Early or Late Hematoma Evacuation? J Clin Med 2023; 12:jcm12041533. [PMID: 36836067 PMCID: PMC9962962 DOI: 10.3390/jcm12041533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Minimally invasive stereotactic catheter aspiration becoming a promising surgical alternative for intracerebral hemorrhage (ICH) patients. Our goal is to determine the risk factors that lead to poor functional outcomes in patients undergoing this procedure. METHODS Clinical data of 101 patients with stereotactic catheter ICH aspiration were retrospectively reviewed. Univariate and multiple logistic analyses were used to identify risk factors for poor outcomes 3 months and 1 year after discharge. Univariate analysis was used to compare the functional outcome between early (<48 h after ICH onset) and late hematoma evacuation (≥48 h after ICH onset) groups, as well as for the odd ratios assessment in terms of rebleeding. RESULTS Independent factors for poor 3-month outcome included lobar ICH, ICH score > 2, rebleeding, and delayed hematoma evacuation. Factors for poor 1-year outcome included age > 60, GCS < 13, lobar ICH, and rebleeding. Early hematoma evacuation was linked to a lower likelihood of poor outcome both 3 months and 1 year post-discharge, but with higher risk of postoperative rebleeding. CONCLUSIONS Lobar ICH and rebleeding independently predicted both poor short- and long-term outcomes in patients with stereotactic catheter ICH evacuation. Early hematoma evacuation with preoperative rebleeding risk evaluation may benefit patients with stereotactic catheter ICH evacuation.
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Affiliation(s)
- Yuanjian Fang
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou 310009, China
- Correspondence: (Y.F.); (Z.W.); (Y.Z.); Tel.: +86-571-87784719 (Y.F. & Y.Z.); +86-571-87784715 (Z.W.); Fax: +86-571-87784755 (Y.F. & Z.W. & Y.Z.)
| | - Junjie Wang
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
- Department of Neurosurgery, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu 310030, China
| | - Luxi Chen
- Department of Medical Genetics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
- Department of Neurology, Research Center of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Wei Yan
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou 310009, China
| | - Shiqi Gao
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
| | - Yibo Liu
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
| | - Xiaoyu Wang
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
| | - Xiao Dong
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou 310009, China
| | - Jianmin Zhang
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou 310009, China
| | - Sheng Chen
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou 310009, China
| | - Fengqiang Liu
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou 310009, China
| | - Zefeng Wang
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou 310009, China
- Correspondence: (Y.F.); (Z.W.); (Y.Z.); Tel.: +86-571-87784719 (Y.F. & Y.Z.); +86-571-87784715 (Z.W.); Fax: +86-571-87784755 (Y.F. & Z.W. & Y.Z.)
| | - Yang Zhang
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou 310009, China
- Correspondence: (Y.F.); (Z.W.); (Y.Z.); Tel.: +86-571-87784719 (Y.F. & Y.Z.); +86-571-87784715 (Z.W.); Fax: +86-571-87784755 (Y.F. & Z.W. & Y.Z.)
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14
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Ali M, Zhang X, Ascanio LC, Troiani Z, Smith C, Dangayach NS, Liang JW, Selim M, Mocco J, Kellner CP. Long-term functional independence after minimally invasive endoscopic intracerebral hemorrhage evacuation. J Neurosurg 2023; 138:154-164. [PMID: 35561694 DOI: 10.3171/2022.3.jns22286] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/31/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Intracerebral hemorrhage (ICH) is a devastating form of stroke with no proven treatment. However, minimally invasive endoscopic evacuation is a promising potential therapeutic option for ICH. Herein, the authors examine factors associated with long-term functional independence (modified Rankin Scale [mRS] score ≤ 2) in patients with spontaneous ICH who underwent minimally invasive endoscopic evacuation. METHODS Patients with spontaneous supratentorial ICH who had presented to a large urban healthcare system from December 2015 to October 2018 were triaged to a central hospital for minimally invasive endoscopic evacuation. Inclusion criteria for this study included age ≥ 18 years, hematoma volume ≥ 15 ml, National Institutes of Health Stroke Scale (NIHSS) score ≥ 6, premorbid mRS score ≤ 3, and time from ictus ≤ 72 hours. Demographic, clinical, and radiographic factors previously shown to impact functional outcome in ICH were included in a retrospective univariate analysis with patients dichotomized into independent (mRS score ≤ 2) and dependent (mRS score ≥ 3) outcome groups, according to 6-month mRS scores. Factors that reached a threshold of p < 0.05 in a univariate analysis were included in a multivariate logistic regression. RESULTS A total of 90 patients met the study inclusion criteria. The median preoperative hematoma volume was 41 (IQR 27-65) ml and the median postoperative volume was 1.2 (0.3-7.5) ml, resulting in a median evacuation percentage of 97% (85%-99%). The median hospital length of stay was 17 (IQR 9-25) days, and 8 (9%) patients died within 30 days of surgery. Twenty-four (27%) patients had attained functional independence by 6 months. Factors independently associated with long-term functional independence included lower NIHSS score at presentation (OR per point 0.78, 95% CI 0.67-0.91, p = 0.002), lack of intraventricular hemorrhage (IVH; OR 0.20, 95% CI 0.05-0.77, p = 0.02), and shorter time to evacuation (OR per hour 0.95, 95% CI 0.91-0.99, p = 0.007). Specifically, patients who had undergone evacuation within 24 hours of ictus demonstrated an mRS score ≤ 2 rate of 36% and were associated with an increased likelihood of long-term independence (OR 17.7, 95% CI 1.90-164, p = 0.01) as compared to those who had undergone evacuation after 48 hours. CONCLUSIONS In a single-center minimally invasive endoscopic ICH evacuation cohort, NIHSS score on presentation, lack of IVH, and shorter time to evacuation were independently associated with functional independence at 6 months. Factors associated with functional independence may help to better predict populations suitable for minimally invasive endoscopic evacuation and guide protocols for future clinical trials.
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Affiliation(s)
- Muhammad Ali
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Xiangnan Zhang
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Luis C Ascanio
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Zachary Troiani
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Colton Smith
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Neha S Dangayach
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - John W Liang
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Magdy Selim
- 2Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - J Mocco
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Christopher P Kellner
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; and
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15
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Ibrahim A, Arifianto MR, Al Fauzi A. Minimally Invasive Neuroendoscopic Surgery for Spontaneous Intracerebral Hemorrhage: A Review of the Rationale and Associated Complications. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 130:103-108. [PMID: 37548729 DOI: 10.1007/978-3-030-12887-6_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Spontaneous intracerebral hemorrhage (ICH) is associated with a poor prognosis. Its mortality rate exceeds 40%, and 10-15% of survivors remain fully dependent. Considering the limited number of effective therapeutic options in such cases, the possibilities for surgical interventions aimed at removal of a hematoma should always be borne in mind. Although conventional surgery for deep-seated ICH has failed to show an improvement in outcomes, use of minimally invasive techniques-in particular, neuroendoscopic procedures-may be more effective and has demonstrated promising results. Although there are certain risks of morbidities (including rebleeding, epilepsy, meningitis, infection, pneumonia, and digestive tract disorders) and a nonnegligible risk of mortality, their incidence rates after neuroendoscopic evacuation of ICH compare favorably with those after conventional surgery. Prevention of complications requires careful postoperative surveillance of the patient and, preferably, treatment in a neurointensive care unit, as well as early detection and appropriate management of associated comorbidities.
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Affiliation(s)
- Arie Ibrahim
- Department of Neurosurgery, A. Wahab Syahranie Hospital and Faculty of Medicine, Mulawarman University, Kota Samarinda, Kalimantan Timur, Indonesia.
| | - Muhammad Reza Arifianto
- Department of Neurosurgery, Dr. Soetomo General Hospital and Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Asra Al Fauzi
- Department of Neurosurgery, Dr. Soetomo General Hospital and Faculty of Medicine, Airlangga University, Surabaya, Indonesia
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16
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Hallenberger TJ, Guzman R, Bonati LH, Greuter L, Soleman J. Endoscopic surgery for spontaneous supratentorial intracerebral haemorrhage: A systematic review and meta-analysis. Front Neurol 2022; 13:1054106. [PMID: 36605784 PMCID: PMC9807598 DOI: 10.3389/fneur.2022.1054106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Treatment for spontaneous supratentorial intracerebral haemorrhage (SSICH) is limited and consist of either best medical treatment (BMT) or surgical hematoma evacuation. Treatment methods and choice of surgical technique are debated, and so far, no clear advantage of endoscopic surgery (ES) over conventional craniotomy (CC) or BMT was shown. The aim of this systematic review and meta-analysis was to investigate the differences in outcome, morbidity, and mortality between ES and CC or BMT. Methods We systematically searched Embase and PubMed databases for randomised controlled trials comparing ES to CC or BMT. The primary outcome was favourable functional outcome after 6 months. Secondary outcomes were morbidity and mortality rates and duration of surgery. Results Seven articles were eligible for the outcome analysis with 312 subjects in the control (216 CC, 96 BMT) and 279 in the treatment group (ES). Compared to BMT, ES showed significantly improved favourable functional outcome (RR 1.93 [1.12; 3.33], p = 0.02) and mortality rates (RR 0.63 [0.44; 0.90], p = 0.01). No significant difference in favourable functional outcome and mortality was seen in ES compared to CC (RR 2.13 [0.01; 737], p = 0.35; RR 0.42 [0.17; 1.05], p = 0.06). ES showed significantly lower morbidity (RR 0.41 [0.29; 0.58], p < 0.01), and overall infection rates (RR 0.33 [0.20; 0.54], p < 0.01) compared to CC. Duration of surgery was significantly shorter for ES compared to CC (SMD -3.17 [-4.35; -2.00], p < 0.01). Conclusion ES showed significantly improved favourable functional outcome and mortality rates compared to BMT while showing reduced length of surgery and lower complication rates compared to CC. Therefore, ES appears a promising approach for treatment of SSICH justifying further prospective trials. Systematic review registration PROSPERO, identifier: CRD42020181018.
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Affiliation(s)
- Tim J. Hallenberger
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland,Faculty of Medicine, University of Basel, Basel, Switzerland,Division of Paediatric Neurosurgery, Children's University Hospital of Basel, Basel, Switzerland
| | - Leo H. Bonati
- Faculty of Medicine, University of Basel, Basel, Switzerland,Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Ladina Greuter
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Jehuda Soleman
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland,Faculty of Medicine, University of Basel, Basel, Switzerland,Division of Paediatric Neurosurgery, Children's University Hospital of Basel, Basel, Switzerland,*Correspondence: Jehuda Soleman ✉
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17
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Steineke TC, Barbery D. Extended reality platform for minimally invasive endoscopic evacuation of deep-seated intracerebral hemorrhage: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE21390. [PMID: 36593677 PMCID: PMC9514282 DOI: 10.3171/case21390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 07/08/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Extended reality (XR) offers an interactive visualization platform that combines virtual reality (VR) for preoperative planning and augmented reality (AR) for intraoperative navigation overlay. OBSERVATIONS XR was used for treating a case of spontaneous intracerebral hemorrhage (ICH) requiring neurosurgical intervention to decompress a hemorrhage in the subcortical area involving the thalamus that was starting to compress the midbrain. The selected surgical technique was an endoscopic aspiration combined with neurosurgical navigation. Because of the deep-seated location of this ICH, a patient-specific 360XR model rendered using Surgical Theater was used for preoperative planning and intraoperative navigation to allow for enhanced visualization and understanding of the pathology and surrounding anatomy. LESSONS The XR platform enabled visualization of critical structures near the ICH by extracting and highlighting the white matter tracts from magnetic resonance imaging (MRI) with tractography, which improved preoperative planning beyond using state-of-the-art neuronavigation techniques alone. Once the trajectory was set, the model was integrated with the neuronavigation system, and the planned approach was referenced throughout the procedure to evacuate the clots without further injuring the brain. The patient tolerated the procedure well and was doing well 11 months after his spontaneous ICH.
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Affiliation(s)
- Thomas C. Steineke
- Department of Neurosurgery, JFK Neuroscience Institute at Hackensack Meridian Health JFK University Medical Center, Edison, New Jersey; and
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Song R, Ali M, Smith C, Jankowitz B, Hom D, Mocco J, Kellner CP. Initial Experience With the NICO Myriad Device for Minimally Invasive Endoscopic Evacuation of Intracerebral Hemorrhage. Oper Neurosurg (Hagerstown) 2022; 23:194-199. [PMID: 35972081 PMCID: PMC10593260 DOI: 10.1227/ons.0000000000000304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 04/03/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) is a devastating form of stroke for which there is no consensus treatment. Although open craniotomy has been explored as a surgical treatment option, multiple minimally invasive (MIS) techniques have been developed including endoscopic evacuation. An adjunctive aspiration device can be used through the working channel to provide an additional degree of freedom and increased functionality regarding clot manipulation and morcellation. OBJECTIVE To report our single-center technical experience with the Myriad device used as an adjunctive aspiration device during endoscopic ICH evacuation in an exploratory case series. METHODS Demographic, clinical, and radiographic data were collected on patients who underwent MIS endoscopic ICH evacuation using the Myriad aspiration device from December 2018 to March 2019. RESULTS Eight patients underwent ICH evacuation with the Myriad aspiration device. Bleeding was confined to the cortex in 4 patients, subcortical region in 2 patients, and the cerebellum in 2 patients. One of the cerebellar cases also underwent suboccipital craniotomy. The mean preoperative hematoma volume was 65.1 ± 68.9 mL, and the median postoperative volume was 7.6 ± 9.0 mL, for an average evacuation percentage of 88.1% ± 12.1%. In 75% of the cases, a bleeding vessel was identified and treated with either cautery or irrigation alone. There was no hemorrhagic recurrence or mortality within 30 days. CONCLUSION Data from this initial experience suggest that MIS endoscopic ICH evacuation with the NICO Myriad aspiration device is feasible and technically effective. Multicenter exposure is necessary to verify broader applicability.
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Affiliation(s)
- Rui Song
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Colton Smith
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brian Jankowitz
- Department of Neurosurgery, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Danny Hom
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christopher P. Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Wang N, Lin W, Zhu X, Tu Q, Zhu D, Qu S, Yang J, Ruan L, Zhuge Q. Conventional craniotomy versus conservative treatment in patients with minor spontaneous intracerebral hemorrhage in the basal ganglia. Chin Neurosurg J 2022; 8:26. [PMID: 35986426 PMCID: PMC9389702 DOI: 10.1186/s41016-022-00288-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 07/05/2022] [Indexed: 11/20/2022] Open
Abstract
Background The treatment for spontaneous intracerebral hemorrhage (ICH) is still controversial, especially for hematomas in the basal ganglia. A retrospective case-control study with propensity score matching was performed to compare the outcomes of conventional craniotomy and conservative treatment for patients with minor ICH in the basal ganglia. Methods We retrospectively collected the data of consecutive patients with minor basal ganglia hemorrhage from January 2018 to August 2019. We compared clinical outcomes of two groups using propensity score matching. The extended Glasgow outcome scale obtained by phone interviews based on questionnaires at a 12-month follow-up was used as the primary outcome measure. According to a previous prognosis algorithm, patients were divided into good and poor prognosis groups to obtain a dichotomized (favorable or unfavorable) outcome as the primary outcome. Secondary outcomes included hospitalized complications, mortality, and modified Rankin score at 12 months. Results A total of 54 patients were analyzed, and the baseline characteristics of patients in the surgery and conservative treatment groups were well matched. The primary favorable outcome at 12 months was significantly higher in the conservative treatment group than in the surgery group (81% vs 44%; OR 1.833, 95% CI 1.159–2.900; P=0.005). The incidence of pneumonia in the surgery group was significantly higher than that in the conservative treatment group (P=0.005). Conclusions It is not recommended to undertake conventional craniotomy for patients with a minor hematoma (25–40 ml) in the basal ganglia. An open craniotomy might induce worse long-term functional outcomes than the conservative treatment.
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Mei L, Fengqun M, Xiaozhuo L, Qing W, Mingming F, Zhengyao Z, Dongpo S, Qian H, Tong C. Effect Western Medicines Combined With Nao-Xue-Shu in Patients With Hypertensive Intracerebral Hemorrhage: A Network Meta-Analysis. Front Pharmacol 2022; 13:892904. [PMID: 35784744 PMCID: PMC9240398 DOI: 10.3389/fphar.2022.892904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/30/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose: To explore the efficacy of nimodipine, nifedipine, and edaravone (EDA) combined with Nao-Xue-Shu in patients with hypertensive intracerebral hemorrhage (HICH) and to determine the best western medicine combined with Nao-Xue-Shu for treating HICH patients using a ranking method. Methods: After a comprehensive search of the China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP information database, Chinese Biomedical Database (CBM), PubMed, Embase, and Cochrane Library database from the database establishment 31 December 2021, data extraction and quality assessment were conducted for the included articles. The primary outcome measure was the effectiveness after treatment. Secondary outcome measures were after-treatment the National Institutes of Health Stroke Scale (NIHSS) scores, hematoma volume, perihematoma edema volume, and inflammatory factor expression levels. Statistical analyses were performed using Stata 16.0 and RevMan 5.3.0 software. Results: We included 19 randomized controlled trials (RCTs) and six non-RCTs. The effective rate after treatment was ranked from the best to the worst as follows: routine cure measure (RCM) + nifedipine + Nao-Xue-Shu, RCM + EDA + Nao-Xue-Shu, RCM + Nao-Xue-Shu, RCM + nimodipine + Nao-Xue-Shu, RCM + EDA, and RCM. The post-treatment NHISS scores from lowest to highest were as follows: RCM + EDA + Nao-Xue-Shu, RCM + nifedipine + Nao-Xue-Shu, RCM + EDA, RCM + nimodipine + Nao-Xue-Shu, RCM + Nao-Xue-Shu, RCM + Nao-Xue-Kang, and RCM. The post-treatment hematoma volume from minimum to maximum was as follows: RCM + EDA + Nao-Xue-Shu, RCM + nimodipine + Nao-Xue-Shu, RCM + nifedipine + Nao-Xue-Shu, RCM + Nao-Xue-Shu, RCM + Nao-Xue-Kang, and RCM. The post-treatment perihematoma edema volume from minimum to maximum was as follows: RCM + EDA + Nao-Xue-Shu, RCM + nifedipine + Nao-Xue-Shu, RCM + nimodipine + Nao-Xue-Shu, RCM + Nao-Xue-Shu, and RCM. For inflammatory factor expression levels after treatment, IL-6 concentration levels after treatment from lowest to highest wasas follows: RCM + Nao-Xue-Shu, RCM + nifedipine + Nao-Xue-Shu, RCM + nimodipine + Nao-Xue-Shu, RCM + EDA + Nao-Xue-Shu, and RCM. TNF-α concentration levels after treatment from lowest to highest was as follow: RCM + nimodipine + Nao-Xue-Shu, RCM + nifedipine + Nao-Xue-Shu, RCM + Nao-Xue-Shu, and RCM. Conclusion: Nao-Xue-Shu combined with nifedipine showed better effectiveness after treatment in HICH patients compared with the other combinations. Nao-Xue-Shu combined with EDA was more effective for improving neurological function and reducing both hematoma and edema volumes around the hematoma compared with the other combinations. However, Nao-Xue-Shu alone or Nao-Xue-Shu combined with nimodipine may be more effective for reducing proinflammatory factor expression.
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Affiliation(s)
- Li Mei
- Department of Neurosurgery, North China University of Science and Technology Affiliated Hospital, Tangshan, China
| | - Mu Fengqun
- Department of Neurology, Gongren Hospital, Tangshan, China
| | - Liu Xiaozhuo
- Department of Neurosurgery, North China University of Science and Technology Affiliated Hospital, Tangshan, China
| | - Wang Qing
- Department of Neurosurgery, North China University of Science and Technology Affiliated Hospital, Tangshan, China
| | - Fan Mingming
- Department of Neurosurgery, North China University of Science and Technology Affiliated Hospital, Tangshan, China
| | - Zuo Zhengyao
- Department of Neurosurgery, North China University of Science and Technology Affiliated Hospital, Tangshan, China
| | - Su Dongpo
- Department of Neurosurgery, North China University of Science and Technology Affiliated Hospital, Tangshan, China
| | - Han Qian
- Department of Neurosurgery, North China University of Science and Technology Affiliated Hospital, Tangshan, China
| | - Chen Tong
- Department of Neurosurgery, North China University of Science and Technology Affiliated Hospital, Tangshan, China
- *Correspondence: Chen Tong,
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21
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Greenberg SM, Ziai WC, Cordonnier C, Dowlatshahi D, Francis B, Goldstein JN, Hemphill JC, Johnson R, Keigher KM, Mack WJ, Mocco J, Newton EJ, Ruff IM, Sansing LH, Schulman S, Selim MH, Sheth KN, Sprigg N, Sunnerhagen KS. 2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association. Stroke 2022; 53:e282-e361. [PMID: 35579034 DOI: 10.1161/str.0000000000000407] [Citation(s) in RCA: 333] [Impact Index Per Article: 166.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - William J Mack
- AHA Stroke Council Scientific Statement Oversight Committee on Clinical Practice Guideline liaison
| | | | | | - Ilana M Ruff
- AHA Stroke Council Stroke Performance Measures Oversight Committee liaison
| | | | | | | | - Kevin N Sheth
- AHA Stroke Council Scientific Statement Oversight Committee on Clinical Practice Guideline liaison.,AAN representative
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22
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Zheng Z, Wang Q, Sun S, Luo J. Minimally Invasive Surgery for Intracerebral and Intraventricular Hemorrhage. Front Neurol 2022; 13:755501. [PMID: 35273553 PMCID: PMC8901716 DOI: 10.3389/fneur.2022.755501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Spontaneous intracerebral hemorrhage (ICH), especially related to intraventricular hemorrhage (IVH), is the most devastating type of stroke and is associated with high mortality and morbidity. Optimal management of ICH remains one of the most controversial areas of neurosurgery and no effective treatment exists for ICH. Studies comparing conventional surgical interventions with optimal medical management failed to show significant benefit. Recent exploration of minimally invasive surgery for ICH and IVH including catheter- and mechanical-based approaches has shown great promise. Early phase clinical trials have confirmed the safety and preliminary treatment effect of minimally invasive surgery for ICH and IVH. Pending efficacy data from phase III trials dealing with diverse minimally invasive techniques are likely to shape the treatment of ICH.
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Affiliation(s)
- Zelong Zheng
- The Department of Neurosurgery, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Qi Wang
- Institute of Eco-Environmental and Soil Science, Guangdong Academy of Sciences, Guangzhou, China
| | - Shujie Sun
- Shanghai Clinical Research Centre of Chinese Academy of Sciences, Shanghai, China
| | - Jinbiao Luo
- The Department of Neurosurgery, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
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23
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Yan L, Wang X, Wang T, Shu L, Li Y, Dmytriw AA, Yang K, Xu R, Bai X, Yang B, Lu X, Ma Y, Jiao L. Statins for people with intracerebral hemorrhage. Hippokratia 2022. [DOI: 10.1002/14651858.cd014929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Lin Yan
- Department of Neurosurgery; Xuanwu Hospital, Capital Medical University; Beijing China
| | - Xue Wang
- Medical Library of Xuanwu Hospital; Xuanwu Hospital, Capital Medical University; Beijing China
| | - Tao Wang
- Department of Neurosurgery; Xuanwu Hospital, Capital Medical University; Beijing China
| | - Liqi Shu
- Department of Neurology; The Warren Alpert Medical School of Brown University; Providence Rhode Island USA
| | - Ye Li
- Department of Neurosurgery; Xuanwu Hospital, Capital Medical University; Beijing China
| | - Adam A Dmytriw
- Department of Medical Imaging; University of Toronto; Toronto Canada
| | - Kun Yang
- Department of Evidence-based Medicine; Xuanwu Hospital, Capital Medical University; Beijing China
| | - Ran Xu
- Department of Neurosurgery; Xuanwu Hospital, Capital Medical University; Beijing China
| | - Xuesong Bai
- Department of Neurosurgery; Xuanwu Hospital, Capital Medical University; Beijing China
| | - Bin Yang
- Department of Neurosurgery; Xuanwu Hospital, Capital Medical University; Beijing China
| | - Xia Lu
- Department of Neurosurgery; Xuanwu Hospital, Capital Medical University; Beijing China
| | - Yan Ma
- Department of Neurosurgery; Xuanwu Hospital, Capital Medical University; Beijing China
| | - Liqun Jiao
- Department of Neurosurgery; Xuanwu Hospital, Capital Medical University; Beijing China
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24
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Hou D, Lu Y, Wu D, Tang Y, Dong Q. Minimally Invasive Surgery in Patients With Intracerebral Hemorrhage: A Meta-Analysis of Randomized Controlled Trials. Front Neurol 2022; 12:789757. [PMID: 35095735 PMCID: PMC8793625 DOI: 10.3389/fneur.2021.789757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Minimally invasive surgery for intracerebral hemorrhage (ICH) has been evaluated in clinical trials. Although meta-analyses on this topic have been performed in the past, recent trials have added important information to the results of the comparison. However, little work has been done to compare the effect of MIS and conventional treatment on patient prognosis, especially mortality. Methods: PubMed, EMBASE, Web of Science, Ovid, China National Knowledge Infrastructure, and ClinicalTrials.gov were searched on May 1, 2021, for randomized controlled trials of MIS for spontaneous ICH. The primary outcome was defined as death at follow-up, while the secondary outcome was defined as death in different comparisons between MIS and craniotomy (CT) or medication (Me). Results: The initial search yielded 12 high-quality randomized controlled trials involving 2,100 patients. We analyzed the odds ratios (ORs) for MIS compared with conventional treatment, including Me and conventional CT. The OR and confidence intervals (CIs) of the primary and secondary outcomes were 0.62 (0.45–0.85) for MIS vs. conventional treatment. We also conducted subgroup analyses and found that the ORs and CIs for MIS compared with that of conventional treatment in the short-term follow-up were 0.58 (0.42–0.80), and, in the long-term follow-up, was 0.67 (0.46–0.98); and found that ORs were 0.68 (0.48–0.98) for MIS vs. CT and 0.57 (0.41–0.79) for MIS vs. Me. Conclusions: This meta-analysis demonstrates that certain patients with ICH benefit in short- and long-term follow-up from MIS over other treatments, including open surgery and conventional Me. Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/.
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Affiliation(s)
- Duanlu Hou
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Ying Lu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Danhong Wu
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Yuping Tang
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China.,Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
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25
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Patra DP, Welz ME, Turcotte EL, Pandey R, Vij K, Daly M, Rabon M, Korszen S, Zhou Y, Halpin B, Marchese ML, Syal A, Krishna C, Bendok BR. Real-Time MRI-Guided Stereotactic Aspiration of Spontaneous Intracerebral Hematoma: A Preclinical Feasibility Study. Oper Neurosurg (Hagerstown) 2022; 22:80-86. [PMID: 35007273 DOI: 10.1227/ons.0000000000000005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 08/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Minimally invasive surgical techniques have reinvigorated the role of surgical options for spontaneous intracranial hematomas; however, they are limited by the lack of real-time feedback on the extent of hematoma evacuation. OBJECTIVE To describe the development of a MRI-guided catheter-based aspiration system, the ClearPoint Pursuit Neuroaspiration Device (ClearPoint Neuro) and validation in phantom models. METHODS In this preclinical experimental trial, 8 phantom brains with skull models were created to simulate an intracranial hematoma with 2 clot sizes, 30 cc (small clot) and 60 cc (large clot). After registration, the aspiration catheter (Pursuit device) was aligned to the desired planned trajectory. The aspiration of the clot was performed under real-time MRI scan in 3 orthogonal views. The primary end point was reduction of the clot volume to less than 15 cc or 70% of the original clot volume. RESULTS Successful completion of clot evacuation was achieved in all models. The average postaspiration clot volume was 9.5 cc (8.7 cc for small clots and 10.2 cc for large clots). The average percentage reduction of clot volume was 76.3% (range 58.7%-85.2%). The average total procedure time (from frame registration to final postaspiration clot assessment) was 50 min. The average aspiration time was 6.9 min. CONCLUSION This preclinical trial confirms the feasibility and efficacy of MRI-guided aspiration under real-time image guidance in simulation models for intracranial hematoma. Clinical use of the system in patients would further validate its efficacy and safety.
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Affiliation(s)
- Devi P Patra
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
- Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Matthew E Welz
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
- Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Evelyn L Turcotte
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
- Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Kamal Vij
- ClearPoint Neuro, Inc., Irvine, California, USA
| | - Max Daly
- ClearPoint Neuro, Inc., Irvine, California, USA
| | | | | | - Yuxiang Zhou
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA
| | - Brooke Halpin
- School of Life Sciences, Arizona State University, Tempe, Arizona, USA
| | | | - Arjun Syal
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
- Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Chandan Krishna
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
- Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
- Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA
- Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona, USA
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26
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Akram MJ, Zhao R, Shen X, Yang WS, Deng L, Li ZQ, Hu X, Zhao LB, Xie P, Li Q. Surgical vs. Conservative Management for Lobar Intracerebral Hemorrhage, a Meta-Analysis of Randomized Controlled Trials. Front Neurol 2022; 12:742959. [PMID: 35126280 PMCID: PMC8810825 DOI: 10.3389/fneur.2021.742959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 12/21/2021] [Indexed: 11/26/2022] Open
Abstract
Background Outcomes regarding the conventional surgical and conservative treatment for the lobar intracerebral hemorrhage (ICH) have not been previously compared. The current meta-analysis was designed to review and compile the evidence regarding the management of patients with lobar intracerebral hemorrhage. Methods Online electronic databases, including PubMed, Embase, Medline, Cochrane Library, and Google Scholar, were searched for randomized controlled trials (RCTs). Studies were selected on the basis of the inclusion and exclusion criteria. Trials with CT-confirmed lobar intracerebral hemorrhage patients of which treatment regimen was started within 72 h following the stroke were included. Low quality trials were excluded. Death or dependence was defined as primary outcome and death at the end of the follow up was the secondary outcome. Results One hundred five RCTs were screened and 96 articles were excluded on the basis of abstract. Nine articles were assessed for the eligibility and 7 trials were included that involved 1,102 patients. The Odds ratio (OR) for the primary outcome was 0.80 (95% CI, 0.62–1.04, p = 0.09) and for the secondary outcome was 0.79 (95%CI, 0.60–1.03, p = 0.09). Conclusion Our findings suggested that surgical treatments did not significantly improve the functional outcome as compared with the conservative medical management for patients with lobar ICH.
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Affiliation(s)
- Muhammad Junaid Akram
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Zhao
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Xue Shen
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Wen-Song Yang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- National Health Commission Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lan Deng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zuo-Qiao Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Hu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li-Bo Zhao
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
- Li-Bo Zhao
| | - Peng Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- National Health Commission Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Peng Xie
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- National Health Commission Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Qi Li
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27
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Zhu T, Jiang S, Yang Z, Zhou Z, Li Y, Ma S, Zhuo J. A neuroendoscopic navigation system based on dual-mode augmented reality for minimally invasive surgical treatment of hypertensive intracerebral hemorrhage. Comput Biol Med 2022; 140:105091. [PMID: 34872012 DOI: 10.1016/j.compbiomed.2021.105091] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Hypertensive intracerebral hemorrhage is characterized by a high rate of morbidity, mortality, disability and recurrence. Neuroendoscopy has been utilized for treatment as an advanced technology. However, traditional neuroendoscopy allows professionals to see only tissue surfaces, and the field of vision is limited, which cannot provide spatial guidance. In this study, an AR-based neuroendoscopic navigation system is proposed to assist surgeons in locating and clearing hematoma. METHODS The neuroendoscope can be registered through the vector closed loop algorithm. The single-shot method is designed to register medical images with patients precisely. Real-time AR is realized based on video stream fusion. Dual-mode AR navigation is proposed to provide comprehensive guidance from catheter implantation to hematoma removal. A series of experiments is designed to validate the accuracy and significance of this system. RESULTS The average root mean square error of the registration between medical images and patients is 0.784 mm, and the variance is 0.1426 mm. The pixel mismatching degrees are less than 1% in different AR modes. In catheter implantation experiments, the average error of distance is 1.28 mm, and the variance is 0.43 mm, while the average error of angles is 1.34°, and the variance is 0.45°. Comparative experiments are also conducted to evaluate the feasibility of this system. CONCLUSION This system can provide stereo images with depth information fused with patients to guide surgeons to locate targets and remove hematoma. It has been validated to have high accuracy and feasibility.
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Affiliation(s)
- Tao Zhu
- School of Mechanical Engineering, Tianjin University, Tianjin, 300350, China
| | - Shan Jiang
- School of Mechanical Engineering, Tianjin University, Tianjin, 300350, China.
| | - Zhiyong Yang
- School of Mechanical Engineering, Tianjin University, Tianjin, 300350, China
| | - Zeyang Zhou
- School of Mechanical Engineering, Tianjin University, Tianjin, 300350, China
| | - Yuhua Li
- School of Mechanical Engineering, Tianjin University, Tianjin, 300350, China
| | - Shixing Ma
- School of Mechanical Engineering, Tianjin University, Tianjin, 300350, China
| | - Jie Zhuo
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, 300200, China
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28
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Surgery for Intracerebral Hemorrhage. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00072-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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29
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Historical aspects of the problem of surgical treatment of hemorrhagic stroke. The role of intracranial pressure in the choice of treatment tactics (review of literature). ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.5.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This article provides a literature review of the past 60 years, conducted using keywords through the PubMed Internet resource, dedicated to the methods of surgical treatment of hemorrhagic stroke. The existing published results of clinical studies do not allow us to draw unambiguous conclusions about the superiority of conservative or neurosurgical treatment in relation to the functional recovery of patients. There is a statistical significance of the advantages of surgery based on the prevention of dislocation syndrome, control of intracranial hypertension, and prevention or at least reduction of the effect of blood and its degradation products on the surrounding healthy tissue. However, large randomized controlled trials have failed to demonstrate this benefit in terms of mortality or functional outcome.There are two main areas of hemorrhagic stroke surgery – open surgery and minimally invasive methods. The practice of open surgery is associated with high trauma rates, as well as with certain risks and complications. However, craniotomy is a lifesaving measure in critical situations with signs of persistent increased intracranial pressure leading to neurological impairment. The ability to control intracranial pressure provides a chance for the choice of more optimal tactics of surgical treatment.Today, the gold standard for intracranial pressure monitoring is the installation of invasive intraventricular or intraparenchymal transducers. The method is appreciated for its accuracy, however, there are a number of disadvantages in the form of the possibility of hemorrhagic and infectious complications, as well as the high cost of the sensor itself, which limits its routine use. The inability to measure intracranial pressure before surgery causes an unreasonable expansion of indications for choosing an open method of surgery, which reduces the possibility of a better functional outcome.All of these points make it urgent to search for a non-invasive method for measuring intracranial pressure, which would contribute to the timely choice of a surgical method without the danger of worsening the clinical outcome.
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Management of Intracerebral Hemorrhage: Update and Future Therapies. Curr Neurol Neurosci Rep 2021; 21:57. [PMID: 34599652 DOI: 10.1007/s11910-021-01144-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Intracerebral hemorrhage (ICH) represents about 15% of all strokes in the USA, but almost 50% of fatal strokes. There are many causes of ICH, but the most common are hypertension and cerebral amyloid angiopathy. This review will discuss new advances in the treatment of intracerebral hemorrhage. RECENT FINDINGS The treatment of ICH focuses on management of edema, aggressive blood pressure reduction, and correction of coagulopathy. Early initiation of supportive medical therapies, including blood pressure management, in a neurological intensive care unit reduces mortality, but at present there is no definitive, curative therapy analogous to mechanical thrombectomy for ischemic stroke. Nonetheless, new medical and surgical approaches promise more successful management of ICH patients, especially new approaches to surgical management. In this review, we focus on the current standard of care of acute ICH and discuss emerging therapies that may alter the landscape of this devastating disease.
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31
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Kim JH, Lee HS, Ahn JH, Oh JK, Song JH, Chang IB. Clinical and radiographic factors involved in achieving a hematoma evacuation rate of more than 70% through minimally invasive catheter drainage for spontaneous intracerebral hemorrhage. J Clin Neurosci 2021; 92:103-109. [PMID: 34509234 DOI: 10.1016/j.jocn.2021.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
Although stereotactic or neuronavigation-guided hematoma drainage for spontaneous intracerebral hemorrhage (ICH) is widely used, its clinical efficacy and factors for predictive results remain to be fully elucidated. This study sought to determine the efficacy of hematoma evacuation for spontaneous ICH, in addition to the factors affecting it. We retrospectively reviewed patients who underwent stereotactic or neuronavigation-guided catheter insertion for spontaneous ICH at our institute between April 2010 and December 2019. We identified and compared the clinical and radiographic factors between groups according to the hematoma evacuation rate of 70%. Logistic regression analyses were performed to identify factors affecting hematoma evacuation. We investigated whether the hematoma evacuation rate was associated with patient survival. A total of 95 patients who underwent stereotactic or neuronavigation-guided catheter insertion and hematoma drainage for spontaneous ICH were included. A multivariate analysis indicated that a hematoma volume of 30-60 cm3 (odds ratio [OR] = 8.064, 95% confidence interval [CI] = 2.285-28.468, P = 0.001), blend sign (OR = 6.790, 95% CI = 1.239-37.210, P = 0.027), diabetes (OR = 0.188, 95% CI = 0.041-0.870, P = 0.032), and leukocytosis (OR = 3.061, 95% CI = 1.094-8.563, P = 0.033) were significantly associated with a higher hematoma evacuation. The mean hematoma evacuation rate in patients with 1-month mortality was lower than that in survivors (P = 0.051). Our study revealed that a hematoma volume of 30-60 cm3, the presence of a blend sign and leukocytosis, and the absence of diabetes are independent predictors that affect more than 70% of hematoma evacuations.
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Affiliation(s)
- Ji Hee Kim
- Department of Neurosurgery, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Republic of Korea
| | - Heui Seung Lee
- Department of Neurosurgery, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Republic of Korea
| | - Jun Hyong Ahn
- Department of Neurosurgery, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Republic of Korea
| | - Jae Keun Oh
- Department of Neurosurgery, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Republic of Korea
| | - Joon Ho Song
- Department of Neurosurgery, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Republic of Korea
| | - In Bok Chang
- Department of Neurosurgery, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Republic of Korea.
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Fully endoscopic versus microscopic vascular decompression for hemifacial spasm: a retrospective cohort study. Acta Neurochir (Wien) 2021; 163:2417-2423. [PMID: 33765219 DOI: 10.1007/s00701-021-04824-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Microvascular decompression (MVD) is the preferred surgical method for hemifacial spasm (HFS). The purpose of this study was to analyze the effectiveness and safety of fully endoscopic MVD for HFS relative to microscopic MVD. MATERIAL AND METHODS The retrospective study was conducted on HFS patients who underwent microscopic or fully endoscopic MVD from January 2018 to March 2019. All patients were treated at a single institution and by a single surgeon. Patients were divided into two groups based on the surgical method, and clinical data were then compared between groups. RESULTS A total of 116 patients, including 54 cases who received fully endoscopic MVD (E group) and 62 cases who received microscopic MVD (M group), were included in this study. Follow-up efficacy did not differ significantly between groups, with total effective rates of 88.9% in the E group and 90.3% in the M group. When postoperative complications were compared individually, there were no statistically significant differences between the two groups; however, the E group had a higher total incidence of complications than the M group (48.1% vs. 29.0%, P = 0.034). CONCLUSION Although both fully endoscopic and microscopic MVD for HFS achieved good efficacy, the former method had a higher total incidence of complications. Based on the results of this study, there is no evidence that a microscope can be replaced by a full endoscope in MVD for HFS.
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Zyck S, Du L, Gould G, Latorre JG, Beutler T, Bodman A, Krishnamurthy S. Scoping Review and Commentary on Prognostication for Patients with Intracerebral Hemorrhage with Advances in Surgical Techniques. Neurocrit Care 2021; 33:256-272. [PMID: 32270428 DOI: 10.1007/s12028-020-00962-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The intracerebral hemorrhage (ICH) score provides an estimate of 30-day mortality for patients with intracerebral hemorrhage in order to guide research protocols and clinical decision making. Several variations of such scoring systems have attempted to optimize its prognostic value. More recently, minimally invasive surgical techniques are increasingly being used with promising results. As more patients become candidates for surgical intervention, there is a need to re-discuss the best methods for predicting outcomes with or without surgical intervention. METHODS We systematically performed a scoping review with a comprehensive literature search by two independent reviewers using the PubMed and Cochrane databases for articles pertaining to the "intracerebral hemorrhage score." Relevant articles were selected for analysis and discussion of potential modifications to account for increasing surgical indications. RESULTS A total of 64 articles were reviewed in depth and identified 37 clinical grading scales for prognostication of spontaneous intracerebral hemorrhage. The original ICH score remains the most widely used and validated. Various authors proposed modifications for improved prognostic accuracy, though no single scale showed consistent superiority. Most recently, scales to account for advances in surgical techniques have been developed but lack external validation. CONCLUSION We provide the most comprehensive review to date of prognostic grading scales for patients with intracerebral hemorrhage. Current prognostic tools for patients with intracerebral hemorrhage remain limited and may overestimate risk of a poor outcome. As minimally invasive surgical techniques are developed, prognostic scales should account for surgical candidacy and outcomes.
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Affiliation(s)
- Stephanie Zyck
- Department of Neurosurgery, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY, 13210, USA.
| | - Lydia Du
- Northeast Ohio Medical University, Rootstown, OH, USA
| | - Grahame Gould
- Department of Neurosurgery, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY, 13210, USA
| | | | - Timothy Beutler
- Department of Neurosurgery, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY, 13210, USA
| | - Alexa Bodman
- Department of Neurosurgery, Emory University, Atlanta, GA, USA
| | - Satish Krishnamurthy
- Department of Neurosurgery, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY, 13210, USA
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Alan N, Patel A, Abou-Al-Shaar H, Agarwal N, Zenonos GA, Jankowitz BT, Gross BA. Intraparenchymal hematoma and intraventricular catheter placement using robotic stereotactic assistance (ROSA): A single center preliminary experience. J Clin Neurosci 2021; 91:391-395. [PMID: 34373057 DOI: 10.1016/j.jocn.2021.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Large supratentorial intraparenchymal hemorrhages are managed emergently with image-guided catheters that aim to minimize injury to surrounding parenchyma. Robotic assistance may offer advantages for stereotactic guidance and placement of such catheters. We describe our center's experience with minimally invasive ROSA-assisted intraventricular and intraparenchymal hemorrhage catheter placement and delineate its safety and outcomes. METHODS A retrospective analysis was performed including all patients with intraparenchymal hematoma that underwent ROSA-assisted intraparenchymal and intraventricular catheter placement at the University of Pittsburgh Medical Center between 2017 and 2019. All patients received tissue plasminogen activator (tPA) through the intraparenchymal catheter. We performed a manual chart review of these patients. Pertinent clinical and radiological characteristics and patient outcomes were recorded and analyzed. Catheter trajectory was independently quantified and analyzed by two independent reviewers. Error between the planned trajectory and final position was calculated and analyzed. RESULTS Four patients (2 males and 2 females, mean age of 64 years) with deep brain large volume intraparenchymal hemorrhages were treated with catheter evacuation with robotic assistance. For 2 of the 4 patients, thin-cut CT imaging allowed for the real trajectory of the catheter to be compared to the targeted trajectory to calculate error. The mean error of catheter placement was 3.48 mm. ROSA-assisted catheter placement achieved up to 95% reduction of intraparenchymal hematoma volume with a statistically significant decrease following catheter drainage (pre- 51.8 ± 19.1 cc vs. post- 13.0 ± 14.4; p < 0.01). CONCLUSION Robotic stereotactic assistance offers a safe and sufficiently accurate technique for intraparenchymal hematoma and intraventricular catheter placement.
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Affiliation(s)
- Nima Alan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Aneek Patel
- Department of Neurosurgery, New York University School of Medicine, New York, NY, United States
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Georgios A Zenonos
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
| | - Bradley A Gross
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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Elbaroody M, Ghoneim MA, El Fiki A, Hozayen H, El-Mahdy W. Short-term outcomes of endoscopic evacuation of supratentorial spontaneous intracerebral hematoma: Early experience from developing country. Surg Neurol Int 2021; 12:309. [PMID: 34345450 PMCID: PMC8326093 DOI: 10.25259/sni_118_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/18/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Minimally invasive endoscopic hematoma evacuation is a promising treatment option for intracerebral hemorrhage (ICH). However, the technique still needs improvement. Methods: We report our early clinical experience of using this technique to evacuate supratentorial spontaneous intracerebral hematomas and evaluate its short-term outcomes. Results: The study included 15 patients, basal ganglia hematoma was the most common location 62.5%, mean preoperative hematoma volume was 61.07 cc, mean ICH score was 3, and mean rate of hematoma evacuation was 89.27%. Factors that could be related to mortality were Glasgow Coma Score (GCS) on admission (P = 0.001), ICH score (P = 0.004); postoperative GCS (P < 0.001), postoperative hematoma volume (P = 0.006); intraventricular extension (P = 0.001), and rate of evacuation (P = 0.001). Conclusion: Endoscopic technique is a safe surgical option for evacuation of spontaneous supratentorial ICH. This minimally invasive technique could be helpful to provide better short-term outcomes for selected patients. However, in our experience, this minimally invasive technique did not change the outcome for cases presented with poor GCS on admission 4/15. Our results warrant a future prospective, randomized, controlled efficacy trial.
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Affiliation(s)
- Mohammad Elbaroody
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Ahmed El Fiki
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hesham Hozayen
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Wael El-Mahdy
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
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Rothrock RJ, Chartrain AG, Scaggiante J, Pan J, Song R, Hom D, Lieber AC, Bederson JB, Mocco J, Kellner CP. Advanced Techniques for Endoscopic Intracerebral Hemorrhage Evacuation: A Technical Report With Case Examples. Oper Neurosurg (Hagerstown) 2021; 20:119-129. [PMID: 32322895 PMCID: PMC8044389 DOI: 10.1093/ons/opaa089] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/10/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND 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. OBJECTIVE To describe operative nuances of endoscopic minimally invasive ICH evacuation developed at a single center over an experience of 80 procedures. METHODS Endoscopic minimally invasive ICH evacuation was performed on 79 consecutive eligible patients who presented a single Health System between March 2016 and May 2018. We summarize 4 core operative tenets and 4 main techniques used in 80 procedures. RESULTS A total of 80 endoscopic minimally invasive ICH evacuations were performed utilizing the described surgical techniques. The average preoperative and postoperative volumes were 49.5 mL (standard deviation [SD] 31.1 mL, interquartile range [IQR] 30.2) and 5.4 mL (SD 9.6, mL IQR 5.1), respectively, with an average evacuation rate of 88.7%. All cause 30-d mortality was 8.9%. CONCLUSION As experience builds with endoscopic minimally invasive ICH evacuation, academic discussion of specific surgical techniques will be critical to maximizing its safety and efficacy.
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Affiliation(s)
- Robert J Rothrock
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexander G Chartrain
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jacopo Scaggiante
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jonathan Pan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rui Song
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Danny Hom
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Adam C Lieber
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joshua B Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Christopher P Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
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When the Blood Hits Your Brain: The Neurotoxicity of Extravasated Blood. Int J Mol Sci 2021; 22:ijms22105132. [PMID: 34066240 PMCID: PMC8151992 DOI: 10.3390/ijms22105132] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/30/2021] [Accepted: 05/06/2021] [Indexed: 12/15/2022] Open
Abstract
Hemorrhage in the central nervous system (CNS), including intracerebral hemorrhage (ICH), intraventricular hemorrhage (IVH), and aneurysmal subarachnoid hemorrhage (aSAH), remains highly morbid. Trials of medical management for these conditions over recent decades have been largely unsuccessful in improving outcome and reducing mortality. Beyond its role in creating mass effect, the presence of extravasated blood in patients with CNS hemorrhage is generally overlooked. Since trials of surgical intervention to remove CNS hemorrhage have been generally unsuccessful, the potent neurotoxicity of blood is generally viewed as a basic scientific curiosity rather than a clinically meaningful factor. In this review, we evaluate the direct role of blood as a neurotoxin and its subsequent clinical relevance. We first describe the molecular mechanisms of blood neurotoxicity. We then evaluate the clinical literature that directly relates to the evacuation of CNS hemorrhage. We posit that the efficacy of clot removal is a critical factor in outcome following surgical intervention. Future interventions for CNS hemorrhage should be guided by the principle that blood is exquisitely toxic to the brain.
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Huang C, Chen JC. The Long-Term Survival of Intracranial Hemorrhage Patients Successfully Weaned from Prolonged Mechanical Ventilation. Int J Gen Med 2021; 14:1197-1203. [PMID: 33854361 PMCID: PMC8039841 DOI: 10.2147/ijgm.s304228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/12/2021] [Indexed: 12/30/2022] Open
Abstract
Background Ninety-one intracranial hemorrhage prolonged mechanical ventilation patients were successfully weaned from the ventilator. No article had discussed the factors related to 1-year survival in successfully weaned prolonged mechanical ventilation patients with intracranial hemorrhage. This study aimed to evaluate the factors influencing the one-year survival of successfully weaned intracranial hemorrhage prolonged mechanical ventilation patients. The identification of patients with a poor long-term prognosis could guide long-term care decisions after discharge in such patients. Patients and Methods We performed this retrospective study on the respiratory care center of Dalin Tzu Chi hospital and enrolled all successfully weaned intracranial hemorrhage prolonged mechanical ventilation patients between 1 January 2012 and 31 December 2017. We analyzed data including age, gender, comorbidities, intracranial hemorrhage type, spontaneous or traumatic intracranial hemorrhage, location of intracerebral hemorrhage, presence or not of an intraventricular hemorrhage, Glasgow Coma Scale, receipt or not of intracranial hemorrhage surgery, receipt or not of tracheostomy, long-term survival, and end-of-life decisions. Results We had long-term follow-up data on 69 of these successfully weaned intracranial hemorrhage prolonged mechanical ventilation patients. The 1-year survival rate of successfully weaned patients was 43.5%. The factors unrelated to the 1-year survival rate were comorbidities, intracranial hemorrhage type, spontaneous or traumatic intracranial hemorrhage, location of the intracerebral hemorrhage, presence or not of an intraventricular hemorrhage, intracranial hemorrhage surgery, and tracheostomy. Four factors were independently associated with the 1-year survival rate of these patients: Glasgow Coma Scale score at discharge from the respiratory care center, age ≥ 65 years, signed do-not-resuscitate and do-not-intubate orders, and the absence of comorbidity. Conclusion This study emphasizes an important key factor in terms of the survival of successfully weaned intracranial hemorrhage prolonged mechanical ventilation patients. The patient’s Glasgow Coma Scale score at discharge from the respiratory care center is an important predictor of outcomes. These results can help physician better plan the clinical course for intracranial hemorrhage prolonged mechanical ventilation patients.
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Affiliation(s)
- Chienhsiu Huang
- Department of Internal Medicine, Division of Chest Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Jin-Cherng Chen
- Department of Surgery, Division of Neurosurgery, Dalin Tzu Chi Hospital, Chiayi, Taiwan.,School of Medicine, Tzuchi University, Hualien, Taiwan
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Ray PS. Surgery for Spontaneous Intracerebral Hemorrhage: Current Concept. INDIAN JOURNAL OF NEUROSURGERY 2021. [DOI: 10.1055/s-0041-1726865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Partha S. Ray
- Department of Neurology and Clinical Neurophysiology, The Walton Centre for Neurology, National Health Service, Liverpool, United Kingdom
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Hannah TC, Kellner R, Kellner CP. Minimally Invasive Intracerebral Hemorrhage Evacuation Techniques: A Review. Diagnostics (Basel) 2021; 11:diagnostics11030576. [PMID: 33806790 PMCID: PMC8005063 DOI: 10.3390/diagnostics11030576] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 12/30/2022] Open
Abstract
Intracerebral hemorrhage (ICH) continues to have high morbidity and mortality. Improving ICH outcomes likely requires rapid removal of blood from the parenchyma and restraining edema formation while also limiting further neuronal damage due to the surgical intervention. Minimally invasive surgery (MIS) approaches promise to provide these benefits and have become alluring options for management of ICH. This review describes six MIS techniques for ICH evacuation including craniopuncture, stereotactic aspiration with thrombolysis, endoport-mediated evacuation, endoscope-assisted evacuation, adjunctive aspiration devices, and the surgiscope. The efficacy of each modality is discussed based on current literature. The largest clinical trials have yet to demonstrate definitive effects of MIS intervention on mortality and functional outcomes for ICH. Thus, there is a significant need for further innovation for ICH treatment. Multiple ongoing trials promise to better clarify the potential of the newer, non-thrombolytic MIS techniques.
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Patel SK, Saleh MS, Body A, Zuccarello M. Surgical Interventions for Supratentorial Intracranial Hemorrhage: The Past, Present, and Future. Semin Neurol 2021; 41:54-66. [PMID: 33511606 DOI: 10.1055/s-0040-1722639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Spontaneous supratentorial intracranial hemorrhage is extremely disabling and is associated with high mortality. Primary treatment for patients with this disease process is maximal medical management with blood pressure control and correction of clotting disorders due to comorbid conditions or medications. Over the past decade, significant strides have been made in understanding the benefits of surgical intervention in the treatment of intracranial hemorrhage through multiple clinical trials. In this article, we review the evolution of surgical treatments beginning with the STICH trials, discuss new developments with minimally invasive surgical strategies, and provide a brief update regarding ongoing trials and future directions in the treatment of spontaneous supratentorial intracranial hemorrhage.
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Affiliation(s)
- Smruti K Patel
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mohamed S Saleh
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alaina Body
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mario Zuccarello
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.,University of Cincinnati Gardner Neuroscience Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Godkov I, Dashyan V. Intracerebral hemorrhage grading scales for the prediction of stroke outcome. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:15-19. [DOI: 10.17116/jnevro202112112215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Intraoperative CT and cone-beam CT imaging for minimally invasive evacuation of spontaneous intracerebral hemorrhage. Acta Neurochir (Wien) 2020; 162:3167-3177. [PMID: 32193726 PMCID: PMC7593312 DOI: 10.1007/s00701-020-04284-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/04/2020] [Indexed: 01/25/2023]
Abstract
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 < 0.0001 vs. Pre-OP). Based on the intraoperative imaging results, 1/3rd of all patients underwent an immediate re-aspiration attempt. No patient experienced hemorrhagic complications or required conversion to open craniotomy. However, routine postoperative CT imaging revealed early hematoma re-expansion with an adjusted evacuation rate of 59 ± 30% (residual hematoma volume: 26 ± 37 ml; p < 0.001 vs. Pre-OP). Conclusions Routine utilization of iCT or CBCT imaging in MIS for ICH permits direct surgical performance assessment and the chance for immediate re-aspiration, which may optimize targeting of an ideal residual hematoma volume and reduce secondary revision rates. Electronic supplementary material The online version of this article (10.1007/s00701-020-04284-y) contains supplementary material, which is available to authorized users.
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Yagi K, Tao Y, Hara K, Kanda E, Hirai S, Takai H, Kinoshita K, Mimani Y, Miyazaki Y, Oyama N, Yagita Y, Matsubara S, Uno M. Increased plasma plasmin-α2-plasmin inhibitor complex levels correlate with postoperative rebleeding after endoscopic surgery for spontaneous intracerebral hemorrhage. Acta Neurochir (Wien) 2020; 162:3129-3136. [PMID: 31781996 DOI: 10.1007/s00701-019-04154-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/18/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Postoperative rebleeding (PR) is one of the most severe complications of endoscopic surgery, often performed to remove spontaneous intracerebral hemorrhage (sICH). However, the risk factors for PR remain unclear. OBJECTIVE This study retrospectively investigated whether increased preoperative plasma plasmin-α2-plasmin inhibitor complex (PIC) levels, indicating activation of fibrinolysis, are associated with PR. METHODS A total of 101 patients underwent endoscopic surgery to evacuate sICH at our institution from January 2010 to June 2019, and 79 patients who underwent examinations of plasma PIC levels at admission with available radiographical data were included. Correlations between PR and increased plasma PIC levels were retrospectively evaluated. RESULTS PR occurred in eight patients (10.1%), and high PIC levels (≥ 4 or 6 μg/ml) were significantly associated with PR. The sensitivities employing high PIC levels of ≥ 4 μg/ml and ≥ 6 μg/ml were both 0.63, and the specificities using the same PIC levels were 0.86 and 0.92, respectively. Multivariable analyses showed that high plasma PIC levels of ≥ 4 μg/ml (odds ratio (OR), 12.77; 95% confidence interval (CI), 1.65-98.77; p = 0.02) or ≥ 6 μg/ml (OR, 18.33; 95% CI, 2.32-144.82; p = 0.006) were independent predictors of PR. CONCLUSIONS This study found that increased plasma PIC levels were associated with PR following the endoscopic evacuation of sICHs, indicating that increased plasma PIC levels could be potentially used to predict PR. Further studies are needed to establish new surgical strategies and adjuvant treatments to improve surgical outcomes in patients with sICH prone to PR.
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Affiliation(s)
- Kenji Yagi
- Department of Neurosurgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Yoshifumi Tao
- Department of Neurosurgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Keijirou Hara
- Department of Neurosurgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Eiichiro Kanda
- Medical Science, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Satoshi Hirai
- Department of Neurosurgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Hiroki Takai
- Department of Neurosurgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Keita Kinoshita
- Department of Neurosurgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Yukari Mimani
- Department of Neurosurgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Yuko Miyazaki
- Department of Neurosurgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Naoki Oyama
- Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yoshiki Yagita
- Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Shunji Matsubara
- Department of Neurosurgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Masaaki Uno
- Department of Neurosurgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
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Robot-assisted neurosurgery versus conventional treatment for intracerebral hemorrhage: A systematic review and meta-analysis. J Clin Neurosci 2020; 82:252-259. [PMID: 33248949 DOI: 10.1016/j.jocn.2020.10.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/24/2020] [Accepted: 10/18/2020] [Indexed: 01/11/2023]
Abstract
The aim of this review is to determine the efficacy and safety of robotic surgery for intracranial hemorrhage (ICH). PICO question was formulated as: whether robot-assisted neurosurgery is more effective and safer than conventional treatment for ICH with respect to drainage time, complications, operation time, extent of evacuation and neurological function improvement. We searched PubMed, Web of Science, Wiley Online, OVID, Embase, Cochrane Library, Clinical Trails, Current Controlled Trials, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), OpenGrey and references of related papers. Key words included robot, robotic, hematoma, hemorrhage and neurosurgery. Then we used Microsoft Excel to collect data. Except from qualitative analysis, we did meta-analysis using Review Manager 5.3. 9 papers were included in qualitative synthesis, 6 in meta-analysis for rebleeding rate and 4 in analysis for operative and drainage time. Qualitative synthesis showed shorter operative time and drainage time, a larger extent of evacuation, better neurological function improvement and less complications in robotic group, while meta-analysis suggested that robot-assisted surgery reduced rebleeding rate compared to other surgical procedures, but whether it is superior to conservative treatment in preventing rebleeding still needs more proof. Meta-analysis for operative and drainage time should be explained cautiously because a significant heterogeneity existed and we supposed that differences in baseline characteristics might influence the results. Finally, we drew a conclusion that robotic neurosurgery is a safe and effective approach which is better than conventional surgery or conservative treatment with respect to rebleeding rate, intracranial infection rate and neurological function improvement.
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Heron-mouth neuroendoscopic sheath-assisted neuroendoscopy plays critical roles in treating hypertensive intraventricular hemorrhage. Wideochir Inne Tech Maloinwazyjne 2020; 16:199-210. [PMID: 33786135 PMCID: PMC7991947 DOI: 10.5114/wiitm.2020.99351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 07/17/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Neuroendoscopy is widely applied for treating hypertensive intracerebral hemorrhage. Aim To explore the effects of heron-mouth neuroendoscopic sheath-assisted neuroendoscopy on treatment of hypertensive intraventricular hemorrhage. Material and methods A type of heron-mouth neuroendoscopic sheath combining the advantages of minimally invasive columnar endoscopic sheath and open operation methods was designed. The end of sheath catheter could be dilated if necessary, without increasing risk of cortex injury. Heron-mouth neuroendoscopic sheath-assisted neuroendoscopy was applied in treatment of hypertensive intraventricular hemorrhage. A total of 19 patients with hypertensive intraventricular hemorrhage were selected and divided into an external ventricular drainage + urokinase group and a neuroendoscopy group. Hematoma clearance rate, surgical time, ventricular drainage time, intracranial infection, hydrocephalus and Glasgow Outcome Score (GOS) at 3 months after the operation were compared between two groups. Results Hematoma clearance rate, ventricular drainage time, mortality rate and GOS at 3 months after surgery in the neuroendoscopy group were significantly better compared to those in the external ventricular drainage + urokinase group (p < 0.05). Postoperative complications, including intracranial infection hydrocephalus and pulmonary infection in the neuroendoscopy group, were less numerous compared to those in the external ventricular drainage + urokinase group, but without statistical significance (p > 0.05). However, surgical time was significantly longer in the neuroendoscopy group compared to that in the external ventricular drainage + urokinase group (p < 0.05). There was no significant difference in incidence rate of hydrocephalus between the two groups (p > 0.05). Conclusions Clinical effects of heron-mouth neuroendoscopic sheath-assisted neuroendoscopy were better than those of external ventricular drainage combining urokinase dissolution in treating hypertensive intraventricular hemorrhage.
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Rychen J, O'Neill A, Lai LT, Bervini D. Natural history and surgical management of spontaneous intracerebral hemorrhage: a systematic review. J Neurosurg Sci 2020; 64:558-570. [PMID: 32972110 DOI: 10.23736/s0390-5616.20.04940-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Management of spontaneous intracerebral hemorrhage (ICH) remains controversial despite efforts to produce high level evidence in the past few years. We systematically examined the pooled literature data on the natural history and surgical management of ICH. EVIDENCE ACQUISITION A systematic review was performed using the PubMed and Embase databases, encompassing English, full-text articles, reporting treatment outcomes for the conservative and surgical management of ICH. EVIDENCE SYNTHESIS A total of 91 studies met the eligibility criteria (total of 16,411 ICH cases). The most common locations for an ICH were the basal ganglia for both the conservative (68.7%) and surgical cohorts (58.4%). Patients in the non-operative group (40.5%) were older (mean age 62.9 years; range 12.0-94.0), had a higher Glasgow Coma Scale (GCS) score at presentation (mean GCS 10.2; range 3-15) and lower ICH volume (mean 36.9 mL). When managed non-operatively, a favorable functional outcome was encountered in 25.7% (95% CI 16.9-34.5) of patients, with a 22.2% (95% CI 16.6-27.8) mortality rate. Patients who underwent surgery (59.5%) were younger (mean age 58.8 years; range 12.0-94.0), had a lower GCS at presentation (mean GCS 8.2; range 3-15) and larger ICH volume (mean 58.3 mL; range 8.2-140.0). Craniotomy with hematoma evacuation was the preferred surgical technique (38.6%). A favorable functional outcome was encountered in 29.8% (95% CI 23.8-35.8) of operated patients, with a 21.3% (95% CI 16.3-26.3) mortality rate. CONCLUSIONS For many ICH cases, the reviewed literature allows to define surgical and conservative candidates. However, there are still some ICH-cases where management remains controversial.
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Affiliation(s)
- Jonathan Rychen
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
| | - Anthea O'Neill
- Department of Neurosurgery, Monash Health, Melbourne, Australia
| | - Leon T Lai
- Department of Neurosurgery, Monash Health, Melbourne, Australia
| | - David Bervini
- Department of Neurosurgery, University Hospital of Bern, Bern, Switzerland -
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Intracranial haemorrhage in kidney, liver and heart recipient patients: A centre experience and literature review. TRANSPLANTATION REPORTS 2020. [DOI: 10.1016/j.tpr.2020.100041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Volbers B, Niesen WD, Amiri-Soltani S, Staykov D, Shah MJ, Lang S, Lücking H, Kuramatsu JB, Huttner HB, Schwab S, Bardutzky J. Bedside Catheter Hematoma Evacuation in Vitamin K Antagonist-Related Intracerebral Hemorrhage: A Safe and Feasible Approach. Front Neurol 2020; 11:807. [PMID: 32922349 PMCID: PMC7456824 DOI: 10.3389/fneur.2020.00807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/29/2020] [Indexed: 12/03/2022] Open
Abstract
Background and Purpose: Although outcome in intracerebral hemorrhage (ICH) patients is generally not improved by surgical intervention, the use of minimally invasive surgery (MIS) has shown promising results. However, vitamin K antagonist (VKA)-related ICH patients are underrepresented in surgical treatment trials. We therefore assessed the safety and efficacy of a bedside MIS approach including local application of urokinase in VKA-related ICH. Methods: Patients with a VKA-related ICH > 20 ml who received bedside hematoma evacuation treatment (n = 21) at the University Medical Center Freiburg were retrospectively included for analysis and compared to a historical control group (n = 35) selected from an institutional database (University Medical Center Erlangen) according to identical inclusion criteria. Propensity score matching was performed to obtain comparable cohorts. The evolution of hematoma and peri-hemorrhagic edema (PHE) volumes, midline shift, and the occurrence of adverse events were analyzed. Furthermore, we assessed the modified Rankin Scale and NIHSS scores recorded at discharge. Results: Propensity score matching resulted in 16 patients per group with well-balanced characteristics. Median ICH volume at admission was 45.7 (IQR: 24.2-56.7) ml in the control group and 48.4 (IQR: 28.7-59.6) ml in the treatment group (p = 0.327). ICH volume at day 7 was less pronounced in the treatment group [MIS: 23.2 ml (IQR: 15.8-32.3) vs. control: 43.2 ml (IQR: 27.5-52.4); p = 0.013], as was the increase in midline shift up to day 7 [MIS: -3.75 mM (IQR: -4.25 to -2) vs. control: 1 mM (IQR: 0-2); p < 0.001]. No group differences were observed in PHE volume on day 7 [MIS: 42.4 ml (IQR: 25.0-72.3) vs. control: 31.0 ml (IQR: 18.8-53.8); p = 0.274] or mRS at discharge [MIS: 5 (IQR: 4-5) and 5 (IQR: 4-5); p = 0.949]. No hematoma expansion was observed. The catheter had to be replaced in 1 patient (6%). Conclusions: Bedside catheter-based hematoma evacuation followed by local thrombolysis with urokinase appears to be feasible and safe in cases of large VKA-related ICH. Further studies that assess the functional outcome associated with this technique are warranted. Clinical Trial Registration: DRKS00007908 (German Clinical Trial Register; www.drks.de).
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Affiliation(s)
- Bastian Volbers
- Department of Neurology, University Medical Center Erlangen-Nuremberg, Erlangen, Germany
| | - Wolf-Dirk Niesen
- Department of Neurology, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Dimitre Staykov
- Department of Neurology, University Medical Center Erlangen-Nuremberg, Erlangen, Germany
- Department of Neurology, Hospital of the Brothers of St. John, Eisenstadt, Austria
| | - Mukesch Johannes Shah
- Department of Neurosurgery, University Medical Center Freiburg, Freiburg im Breisgau, Germany
| | - Stefan Lang
- Department of Neuroradiology, University Medical Center Erlangen-Nuremberg, Erlangen, Germany
| | - Hannes Lücking
- Department of Neuroradiology, University Medical Center Erlangen-Nuremberg, Erlangen, Germany
| | - Joji B. Kuramatsu
- Department of Neurology, University Medical Center Erlangen-Nuremberg, Erlangen, Germany
| | - Hagen B. Huttner
- Department of Neurology, University Medical Center Erlangen-Nuremberg, Erlangen, Germany
| | - Stefan Schwab
- Department of Neurology, University Medical Center Erlangen-Nuremberg, Erlangen, Germany
| | - Jürgen Bardutzky
- Department of Neurology, University of Freiburg, Freiburg im Breisgau, Germany
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Abstract
Spontaneous intracerebral hemorrhage (SICH) is a common stroke subtype, accounting for 10-35% of all stroke. It is the most disabling subtype as well, with disproportionately high rates of morbidity and mortality. Despite numerous advances in neurocritical care and stroke management, the prognosis remains poor, and no medical or surgical interventions have been shown to significantly reduce mortality or improve outcomes. Surgical evacuation of SICH has many theoretical benefits, such as reducing secondary injury, reducing intracranial pressures, and preventing cerebral herniation. However, trials involving open craniotomy for SICH evacuation have not yielded significant clinical benefit, and one thought is that benefit is not seen due to injury to the overlying healthy brain tissue. Therefore, minimally invasive options have increasingly been studied as an option to evacuate the SICH while minimizing injury to healthy tissue. We present here a select review of various minimally-invasive techniques for the evacuation of SICH.
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