Outcomes After Minimally Invasive Parafascicular Surgery for Intracerebral Hemorrhage: A Single-Center Experience

Martin Rutkowski, Ivy Song, William Mack, Gabriel Zada

Research output: Contribution to journalArticle

Abstract

Background: Spontaneous intracerebral hemorrhage (ICH) comprises 10%–15% of strokes with a high mortality (40%) and low rates of functional independence within 6 months (25%). Minimally invasive parafascicular surgery has emerged as a potentially safer option for ICH management. Methods: Data from 25 patients who underwent channel-based ICH evacuation were retrospectively collected regarding demographics, clinical presentation, neuroimaging characteristics, follow-up modified Rankin Scale (mRS) score, Glasgow Coma Scale (GCS) score, and disposition. Results: Sixteen patients were male (64%) and 9 were female (36%), with a mean age of 52 years. There were 4 frontal, 1 occipital, and 20 basal ganglia hemorrhages; 15 (60%) showed intraventricular extension. Seventeen ICHs (68%) and 6 of 7 patient deaths (86%) were left sided. The mean volume was 46 cm3 (range, 13.1–101.2 cm3), and the mean clot reduction was 92%. Left-sided ICH (P = 0.014) and the presence of intraventricular hemorrhage (P = 0.038) were associated with worsened postoperative GCS score. Larger hemorrhages were associated with mortality (66 cm3 vs. 38 cm3; P < 0.005). With a mean follow-up time of 5 months, the median follow-up mRS score was 3.5 (vs. 4 preoperatively), and median follow-up GCS was 15 (vs. 10 preoperatively). Patients with higher postoperative mRS scores and lower postoperative GCS were more likely to die. Conclusions: BrainPath-mediated transsulcal approaches are associated with improved mRS and GCS scores, with low rates of residual hematoma, although further data are needed via controlled studies to determine the importance of hemorrhage location and size, timing of surgical intervention, and long-term patient outcomes.

Original languageEnglish (US)
Pages (from-to)e520-e528
JournalWorld Neurosurgery
Volume132
DOIs
StatePublished - Dec 2019

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Glasgow Coma Scale
Minimally Invasive Surgical Procedures
Cerebral Hemorrhage
Hemorrhage
Basal Ganglia Hemorrhage
Mortality
Neuroimaging
Hematoma
Stroke
Demography

Keywords

  • BrainPath
  • Hematoma
  • ICH
  • MIPS
  • Minimally invasive

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Outcomes After Minimally Invasive Parafascicular Surgery for Intracerebral Hemorrhage : A Single-Center Experience. / Rutkowski, Martin; Song, Ivy; Mack, William; Zada, Gabriel.

In: World Neurosurgery, Vol. 132, 12.2019, p. e520-e528.

Research output: Contribution to journalArticle

Rutkowski, Martin ; Song, Ivy ; Mack, William ; Zada, Gabriel. / Outcomes After Minimally Invasive Parafascicular Surgery for Intracerebral Hemorrhage : A Single-Center Experience. In: World Neurosurgery. 2019 ; Vol. 132. pp. e520-e528.
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title = "Outcomes After Minimally Invasive Parafascicular Surgery for Intracerebral Hemorrhage: A Single-Center Experience",
abstract = "Background: Spontaneous intracerebral hemorrhage (ICH) comprises 10{\%}–15{\%} of strokes with a high mortality (40{\%}) and low rates of functional independence within 6 months (25{\%}). Minimally invasive parafascicular surgery has emerged as a potentially safer option for ICH management. Methods: Data from 25 patients who underwent channel-based ICH evacuation were retrospectively collected regarding demographics, clinical presentation, neuroimaging characteristics, follow-up modified Rankin Scale (mRS) score, Glasgow Coma Scale (GCS) score, and disposition. Results: Sixteen patients were male (64{\%}) and 9 were female (36{\%}), with a mean age of 52 years. There were 4 frontal, 1 occipital, and 20 basal ganglia hemorrhages; 15 (60{\%}) showed intraventricular extension. Seventeen ICHs (68{\%}) and 6 of 7 patient deaths (86{\%}) were left sided. The mean volume was 46 cm3 (range, 13.1–101.2 cm3), and the mean clot reduction was 92{\%}. Left-sided ICH (P = 0.014) and the presence of intraventricular hemorrhage (P = 0.038) were associated with worsened postoperative GCS score. Larger hemorrhages were associated with mortality (66 cm3 vs. 38 cm3; P < 0.005). With a mean follow-up time of 5 months, the median follow-up mRS score was 3.5 (vs. 4 preoperatively), and median follow-up GCS was 15 (vs. 10 preoperatively). Patients with higher postoperative mRS scores and lower postoperative GCS were more likely to die. Conclusions: BrainPath-mediated transsulcal approaches are associated with improved mRS and GCS scores, with low rates of residual hematoma, although further data are needed via controlled studies to determine the importance of hemorrhage location and size, timing of surgical intervention, and long-term patient outcomes.",
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AB - Background: Spontaneous intracerebral hemorrhage (ICH) comprises 10%–15% of strokes with a high mortality (40%) and low rates of functional independence within 6 months (25%). Minimally invasive parafascicular surgery has emerged as a potentially safer option for ICH management. Methods: Data from 25 patients who underwent channel-based ICH evacuation were retrospectively collected regarding demographics, clinical presentation, neuroimaging characteristics, follow-up modified Rankin Scale (mRS) score, Glasgow Coma Scale (GCS) score, and disposition. Results: Sixteen patients were male (64%) and 9 were female (36%), with a mean age of 52 years. There were 4 frontal, 1 occipital, and 20 basal ganglia hemorrhages; 15 (60%) showed intraventricular extension. Seventeen ICHs (68%) and 6 of 7 patient deaths (86%) were left sided. The mean volume was 46 cm3 (range, 13.1–101.2 cm3), and the mean clot reduction was 92%. Left-sided ICH (P = 0.014) and the presence of intraventricular hemorrhage (P = 0.038) were associated with worsened postoperative GCS score. Larger hemorrhages were associated with mortality (66 cm3 vs. 38 cm3; P < 0.005). With a mean follow-up time of 5 months, the median follow-up mRS score was 3.5 (vs. 4 preoperatively), and median follow-up GCS was 15 (vs. 10 preoperatively). Patients with higher postoperative mRS scores and lower postoperative GCS were more likely to die. Conclusions: BrainPath-mediated transsulcal approaches are associated with improved mRS and GCS scores, with low rates of residual hematoma, although further data are needed via controlled studies to determine the importance of hemorrhage location and size, timing of surgical intervention, and long-term patient outcomes.

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