dc.contributor.author
Hecht, Nils
dc.contributor.author
Czabanka, Marcus
dc.contributor.author
Kendlbacher, Paul
dc.contributor.author
Raff, Julia-Helene
dc.contributor.author
Bohner, Georg
dc.contributor.author
Vajkoczy, Peter
dc.date.accessioned
2022-06-23T08:45:38Z
dc.date.available
2022-06-23T08:45:38Z
dc.identifier.uri
https://refubium.fu-berlin.de/handle/fub188/35383
dc.identifier.uri
http://dx.doi.org/10.17169/refubium-35099
dc.description.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.
en
dc.rights.uri
https://creativecommons.org/licenses/by/4.0/
dc.subject
Minimally invasive surgery
en
dc.subject
Intracerebral hemorrhage
en
dc.subject
Intraoperative imaging
en
dc.subject
Cone-beam CT
en
dc.subject
Intraoperative CT
en
dc.subject
Image guidance
en
dc.subject.ddc
600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit
dc.title
Intraoperative CT and cone-beam CT imaging for minimally invasive evacuation of spontaneous intracerebral hemorrhage
dc.type
Wissenschaftlicher Artikel
dcterms.bibliographicCitation.doi
10.1007/s00701-020-04284-y
dcterms.bibliographicCitation.journaltitle
Acta Neurochirurgica
dcterms.bibliographicCitation.number
12
dcterms.bibliographicCitation.originalpublishername
Springer Nature
dcterms.bibliographicCitation.pagestart
3167
dcterms.bibliographicCitation.pageend
3177
dcterms.bibliographicCitation.volume
162
refubium.affiliation
Charité - Universitätsmedizin Berlin
refubium.funding
Springer Nature DEAL
refubium.resourceType.isindependentpub
no
dcterms.accessRights.openaire
open access
dcterms.bibliographicCitation.pmid
32193726
dcterms.isPartOf.issn
0001-6268
dcterms.isPartOf.eissn
0942-0940