title: A minimally invasive anterior skull base approach for evacuation of a basal ganglia hemorrhage.
abstract: We describe the technical nuances of a minimally invasive anterior skull base approach for microsurgical evacuation of a large basal ganglia hematoma through an endoport. Patients who suffer from large spontaneous intracerebral hemorrhages (ICH) of the basal ganglia have a very poor prognosis. However, the benefit of surgery for the management of ICH is controversial. The development of endoport technology has allowed for minimally invasive access to subcortical lesions, and may offer unique advantages over conventional surgical techniques due to less disruption of the overlying cortex and white matter fiber tracts. A 77-year-old man presented with a hypertensive ICH of the right putamen, measuring 9 cm in maximal diameter and 168 cm(3) in volume. We planned an endoport trajectory through the long axis of the hematoma using frameless stereotactic neuronavigation. In order to access the optimal cortical entry point at the lateral aspect of the basal frontal lobe, a miniature modified orbitozygomatic skull base craniotomy was performed through an incision along the superior border of the right eyebrow. Using the BrainPath endoport system (NICO, Indianapolis, IN, USA), the putaminal hematoma was successfully evacuated, resulting in an 87% postoperative reduction in ICH volume. Thus, we show that, in appropriately selected cases, endoport-assisted microsurgery is safe and effective for the evacuation of large ICH. Furthermore, minimally invasive anterior skull base approaches can be employed to expand the therapeutic potential of endoport-assisted approaches to include subcortical lesions, such as hematomas of the basal ganglia.
authors.affiliation: Department of Neurosurgery, Division of Cerebrovascular and Skull Base Surgery, University of Virginia Health System, Post Office Box 800212, Charlottesville, VA 22908, USA.
authors.forename: Dale
authors.initials: D
authors.lastname: Ding
authors.affiliation: School of Medicine, University of Virginia, Charlottesville, VA, USA.
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Przybylowski
authors.affiliation: Department of Neurosurgery, Division of Cerebrovascular and Skull Base Surgery, University of Virginia Health System, Post Office Box 800212, Charlottesville, VA 22908, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.affiliation: Department of Neurosurgery, Division of Cerebrovascular and Skull Base Surgery, University of Virginia Health System, Post Office Box 800212, Charlottesville, VA 22908, USA.
authors.forename: R
authors.initials: R
authors.lastname: Sterling Street
authors.affiliation: Department of Neurosurgery, Division of Cerebrovascular and Skull Base Surgery, University of Virginia Health System, Post Office Box 800212, Charlottesville, VA 22908, USA.
authors.forename: Amber E
authors.initials: AE
authors.lastname: Tyree
authors.affiliation: Department of Neurosurgery, Division of Cerebrovascular and Skull Base Surgery, University of Virginia Health System, Post Office Box 800212, Charlottesville, VA 22908, USA; Department of Radiology, University of Virginia, Charlottesville, VA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Webster Crowley
authors.affiliation: Department of Neurosurgery, Division of Cerebrovascular and Skull Base Surgery, University of Virginia Health System, Post Office Box 800212, Charlottesville, VA 22908, USA; Department of Radiology, University of Virginia, Charlottesville, VA, USA. Electronic address: kenneth.c.liu@virginia.edu.
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Liu
mesh_terms: D020145:Basal Ganglia Hemorrhage / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D006801:Humans; D020299:Intracranial Hemorrhage, Hypertensive / Q000601:surgery; D008297:Male; D008866:Microsurgery; D019060:Minimally Invasive Surgical Procedures; D038361:Neuronavigation / Q000379:methods; D020146:Putaminal Hemorrhage / Q000601:surgery*; D019291:Skull Base / Q000601:surgery*; D016896:Treatment Outcome
keywords: Basal ganglia; Endoport; Intracranial hemorrhages; Microsurgery; Minimally invasive; Stroke