The Safety and Feasibility of Image-Guided BrainPath-Mediated Transsulcul Hematoma Evacuation: A Multicenter Study.
Subcortical injury resulting from conventional surgical management of intracranial hemorrhage may counteract the potential benefits of hematoma evacuation.



To evaluate the safety and potential benefits of a novel, minimally invasive approach for clot evacuation in a multicenter study.



The integrated approach incorporates 5 competencies: (1) image interpretation and trajectory planning, (2) dynamic navigation, (3) atraumatic access system (BrainPath, NICO Corp, Indianapolis, Indiana), (4) extracorporeal optics, and (5) automated atraumatic resection. Twelve neurosurgeons from 11 centers were trained to use this approach through a continuing medical education-accredited course. Demographical, clinical, and radiological data of patients treated over 2 years were analyzed retrospectively.



Thirty-nine consecutive patients were identified. The median Glasgow Coma Scale (GCS) score at presentation was 10 (range, 5-15). The thalamus/basal ganglion regions were involved in 46% of the cases. The median hematoma volume and depth were 36 mL (interquartile range [IQR], 27-65 mL) and 1.4 cm (IQR, 0.3-2.9 cm), respectively. The median time from ictus to surgery was 24.5 hours (IQR, 16-66 hours). The degree of hematoma evacuation was ≥90%, 75% to 89%, and 50% to 74% in 72%, 23%, and 5.0% of the patients, respectively. The median GCS score at discharge was 14 (range, 8-15). The improvement in GCS score was statistically significant ( P < .001). Modified Rankin Scale data were available for 35 patients. Fifty-two percent of those patients had a modified Rankin Scale score of ≤2. There were no mortalities.



The approach was safely performed in all patients with a relatively high rate of clot evacuation and functional independence.
Division of Neurosurgery, Department of Surgery,University of Ottawa,Ottawa,On-tario, Canada.
Mohamed A
MA
Labib
Department of Neurosu-rgery, Goodman Campbell Brain and Spi-ne and Indiana University, Indianapolis, Indiana.
Mitesh
M
Shah
Department of Neurosurg-ery, Aurora Neuroscience and Inn-ovation Institute, Milwaukee, Wisconsin.
Amin B
AB
Kassam
Department of Neurosu-rgery, Goodman Campbell Brain and Spi-ne and Indiana University, Indianapolis, Indiana.
Ronald
R
Young
Department of Neurosurgery, Delray Medical Center, Delray Beach, Florida.
Lloyd
L
Zucker
Department of Neurosurgery, Clear Lake Regional Medical Center, Webster, Texas.
Anthony
A
Maioriello
Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas.
Gavin
G
Britz
Department of Surgery, Otta-wa Civic Hospital, Ottawa, Ontario, Canada.
Charles
C
Agbi
Department of Neurosurgery, University of Arkansas for Medical Sci-ences, Little Rock, Arkansas.
J D
JD
Day
Depart-ment of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland.
Gary
G
Gallia
Depart-ment of Neurosurgery, North Shore-LIJ/Huntington Hospital, Huntington, New York.
Robert
R
Kerr
Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.
Gustavo
G
Pradilla
Department of Neurosurg-ery, Aurora Neuroscience and Inn-ovation Institute, Milwaukee, Wisconsin.
Richard
R
Rovin
Department of Neurosu-rgery, Goodman Campbell Brain and Spi-ne and Indiana University, Indianapolis, Indiana.
Charles
C
Kulwin
Department of Neuro-surgery, NorthShore University Health-System, Evanston, Illinois.
Julian
J
Bailes
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000601:surgery*; D005260:Female; D015600:Glasgow Coma Scale; D006406:Hematoma / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
Intracerebral hemorrhage; Minimally invasive clot evacuation; Stroke; Surgery; Transsulcul