title: Treatment of supratentorial spontaneous intracerebral hemorrhage using image-guided minimally invasive surgery: Initial experiences of a flat detector CT-based puncture planning and navigation system in the angiographic suite.
abstract: OBJECTIVE
  The intracerebral hemorrhage drainage through minimally invasive approach is emerging as an alternative for traditional craniotomy, due to its improved survival rate and reduced complication rate. In this study, we investigated the feasibility and safety of a flat detector CT-based puncture planning and navigation system for minimally invasive hematoma drainage on patients with intracerebral hemorrhage.
  
  
  METHODS
  The minimally invasive hematoma drainage was performed on 21 hypertensive patients with intracerebral hemorrhage in the angiographic suite with the guidance of a flat detector CT-based puncture planning and navigation system. This system is integrated in the angiographic machine, and was used for 1) planning the needle path based on a preprocedural flat detector CT scan, 2) advancing the catheter with real-time fluoroscopic guidance, and 3) confirming the procedure outcome based on an immediate postprocedural flat detector CT. The surgery efficiency, accuracy, and the treatment outcome were measured and compared with the published data.
  
  
  RESULTS
  All procedures were successfully completed with the catheter placed 4 ± 1 mm from the planned position. The average surgery time was 40 ± 7 minutes. The volume of the hematoma was reduced to 28 ± 4% of the original volume. The Glasgow Coma Scale score was significantly improved from 10 ± 1 at the admission to 14 ± 1 at the discharge. The Extended Glasgow Coma Scale score also improved from 5 ± 1 at the discharge to 6 ± 1 at the 6-month follow-up. No major complication, rebleeding, and mortality were observed in this study.
  
  
  CONCLUSIONS
  This flat detector CT-based needle guidance system provided a feasible, convenient, and safe way to perform the puncture and drainage of brain hematoma in the angiographic suite.
authors.affiliation: From the Department of Neurosurgery (Z.Y., B.H., Z.J., J.C., Y.Z., Y.F., J.L.), Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Yang
authors.affiliation: From the Department of Neurosurgery (Z.Y., B.H., Z.J., J.C., Y.Z., Y.F., J.L.), Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: B
authors.initials: B
authors.lastname: Hong
authors.affiliation: From the Department of Neurosurgery (Z.Y., B.H., Z.J., J.C., Y.Z., Y.F., J.L.), Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Jia
authors.affiliation: From the Department of Neurosurgery (Z.Y., B.H., Z.J., J.C., Y.Z., Y.F., J.L.), Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: J
authors.initials: J
authors.lastname: Chen
authors.affiliation: Siemens Ltd. China (J.G., J.H., J.B.), Healthcare Sector, Angiography & Interventional X-Ray Systems, Shanghai, China.
authors.forename: J
authors.initials: J
authors.lastname: Ge
authors.affiliation: Siemens Ltd. China (J.G., J.H., J.B.), Healthcare Sector, Angiography & Interventional X-Ray Systems, Shanghai, China.
authors.forename: J
authors.initials: J
authors.lastname: Han
authors.affiliation: Siemens Ltd. China (J.G., J.H., J.B.), Healthcare Sector, Angiography & Interventional X-Ray Systems, Shanghai, China.
authors.forename: J
authors.initials: J
authors.lastname: Beilner
authors.affiliation: From the Department of Neurosurgery (Z.Y., B.H., Z.J., J.C., Y.Z., Y.F., J.L.), Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: From the Department of Neurosurgery (Z.Y., B.H., Z.J., J.C., Y.Z., Y.F., J.L.), Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Fang
authors.affiliation: From the Department of Neurosurgery (Z.Y., B.H., Z.J., J.C., Y.Z., Y.F., J.L.), Changhai Hospital, Second Military Medical University, Shanghai, China renzhhuang@hotmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Liu
mesh_terms: D000368:Aged; D002533:Cerebral Angiography / Q000379:methods*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery*; D004322:Drainage / Q000379:methods; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D038361:Neuronavigation / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome