Abstract
Traumatic brain injury (TBI) is a major public health problem worldwide that affects all age groups. In the United States alone, there are approximately 50,000 deaths from severe traumatic brain injuries each year. In most studies, about 40 % of severe TBI have associated traumatic intracerebral hemorrhages (tICHs). The surgical treatment of tICH is debated largely because of its invasive nature, particularly in reaching deep tICHs. tICHs have a clear contribution to mass effect and exacerbate cerebral edema and ICP because of the break-down products of hemorrhage. We introduce a modification of the Mi SPACE technique (Minimally Invasive Subcortical Parafascicular Transsulcal Access for Clot Evacuation) that is applicable to tICH. In brief, this technique utilizes a trans-sulcal, stereotactic-guided technique in which a specially designed cannula is used to introduce a 13.5-mm-diameter tube into the epicenter of the tICH. We identified eight tICHs that were treated entirely or in part with the modified Mi SPACE technique during the time period from August 15, 2014 to December 15, 2014. This modified technique was readily deployed safely and efficaciously with significant removal of the tICH as demonstrated by postoperative CT scans. The removal of tICH using this minimally invasive technique may help with the control of ICP and cerebral edema.
Presented in Part at the International Symposium of Cerebral Edema
September 27, 2014
Huntington Beach, California
The Authors declare that they have no potential financial conflicts.
Author contributions:
JC: writing and design of article, evaluation of data, critical appraisal of manuscript
MP: Drawing of Fig. 1, critical appraisal of manuscript
DA: Drawing of Fig. 2, critical appraisal of manuscript
SK: design of article, evaluation of data, critical appraisal of manuscript
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References
Mendelow AD, Gregson BA, Fernandes HM et al (2005) Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet 365:387–397
Mendelow AD, Unterberg A (2007) Surgical treatment of intracerebral haemorrhage. Curr Opin Crit Care 13:169–174
Barnes B, Hanley DF, Carhuapoma JR (2014) Minimally invasive surgery for intracerebral haemorrhage. Curr Opin Crit Care 20:148–152
Morgan T, Zuccarello M, Narayan R, Keyl P, Lane K, Hanley D (2008) Preliminary findings of the minimally-invasive surgery plus rtPA for intracerebral hemorrhage evacuation (MISTIE) clinical trial. Acta Neurochir Suppl 105:147–151
Monteith SJ, Harnof S, Medel R et al (2013) Minimally invasive treatment of intracerebral hemorrhage with magnetic resonance-guided focused ultrasound. J Neurosurg 118:1035–1045
Huang X, Wen L (2010) Technical considerations in decompressive craniectomy in the treatment of traumatic brain injury. Int J Med Sci 7:385–390
Chibbaro S, Di Rocco F, Mirone G et al (2011) Decompressive craniectomy and early cranioplasty for the management of severe head injury: a prospective multicenter study on 147 patients. World Neurosurg 75:558–562
Ahmad FU, Bullock R (2011) Decompressive craniectomy for severe head injury. World Neurosurg 75:451–453
Lund-Johansen M (2011) Decompressive craniectomy for traumatic brain injury-when and how? World Neurosurg 75:454–455
Mathiesen T, Benediktsdottir K, Johnsson H, Lindqvist M, von Holst H (1995) Intracranial traumatic and non-traumatic haemorrhagic complications of warfarin treatment. Acta Neurol Scand 91:208–214
Chi JH (2011) Craniectomy for traumatic brain injury: results from the DECRA trial. Neurosurgery 68:N19–N20
Cooper DJ, Rosenfeld JV, Murray L et al (2011) Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 364:1493–1502
Bor-Seng-Shu E, Figueiredo EG, Amorim RL et al (2012) Decompressive craniectomy: a meta-analysis of influences on intracranial pressure and cerebral perfusion pressure in the treatment of traumatic brain injury. J Neurosurg 117:589–596
Sahuquillo J, Martinez-Ricarte F, Poca MA (2013) Decompressive craniectomy in traumatic brain injury after the DECRA trial. Where do we stand? Curr Opin Crit Care 19:101–106
Ritsma B, Kassam A, Dowlatshahi D, Nguyen T, Stotts G (2014) Minimally invasive subcortical parafascicular transsulcal access for clot evacuation (Mi SPACE) for intracerebral hemorrhage. Case Rep Neurol Med 2014:102307
Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G (1993) Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke 24:987–993
Newman GC (2007) Clarification of abc/2 rule for ICH volume. Stroke 38:862
Jennett B, Snoek J, Bond MR, Brooks N (1981) Disability after severe head injury: observations on the use of the Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry 44:285–293
Inaji M, Tomita H, Tone O, Tamaki M, Suzuki R, Ohno K (2003) Chronological changes of perihematomal edema of human intracerebral hematoma. Acta Neurochir Suppl 86:445–448
Siddique MS, Fernandes HM, Wooldridge TD, Fenwick JD, Slomka P, Mendelow AD (2002) Reversible ischemia around intracerebral hemorrhage: a single-photon emission computerized tomography study. J Neurosurg 96:736–741
Butcher KS, Baird T, MacGregor L, Desmond P, Tress B, Davis S (2004) Perihematomal edema in primary intracerebral hemorrhage is plasma derived. Stroke 35:1879–1885
Xi G, Keep RF, Hoff JT (2006) Mechanisms of brain injury after intracerebral haemorrhage. Lancet Neurol 5:53–63
Mitchell P, Gregson BA, Vindlacheruvu RR, Mendelow AD (2007) Surgical options in ICH including decompressive craniectomy. J Neurol Sci 261:89–98
Siddique MS, Gregson BA, Fernandes HM et al (2002) Comparative study of traumatic and spontaneous intracerebral hemorrhage. J Neurosurg 96:86–89
Francis R, Rowan EN, Gregson BA, Mendelow AD (2011) Traumatic intracerebral hemorrhage–to operate or not? World Neurosurg 76:484–485
Gregson BA, Rowan EN, Mitchell PM et al (2012) Surgical trial in traumatic intracerebral hemorrhage (STITCH(Trauma)): study protocol for a randomized controlled trial. Trials 13:193
Francis R, Gregson BA, Mendelow AD (2014) Attitudes to intracranial pressure monitoring of traumatic intracerebral haemorrhage. Br J Neurosurg 28:663–665
Keep RF, Hua Y, Xi G (2012) Intracerebral haemorrhage: mechanisms of injury and therapeutic targets. Lancet Neurol 11:720–731
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Chen, J.W., Paff, M.R., Abrams-Alexandru, D., Kaloostian, S.W. (2016). Decreasing the Cerebral Edema Associated with Traumatic Intracerebral Hemorrhages: Use of a Minimally Invasive Technique. In: Applegate, R., Chen, G., Feng, H., Zhang, J. (eds) Brain Edema XVI. Acta Neurochirurgica Supplement, vol 121. Springer, Cham. https://doi.org/10.1007/978-3-319-18497-5_48
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DOI: https://doi.org/10.1007/978-3-319-18497-5_48
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