Frameless Stereotactic Aspiration and Thrombolysis of Spontaneous Intracerebral Hemorrhage

Barrett, Ryan J.; Hussain, Rahat; Coplin, William M.; Berry, Samera; Keyl, Penelope M.; Hanley, Daniel F.; Johnson, Robert R.; Carhuapoma, J. Ricardo

doi:10.1385/ncc:3:3:237

Cited by 73 publications

(47 citation statements)

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“…For example, there is evidence demonstrating the safety and technical success of frameless stereotactic intracerebral hemorrhagic aspiration. [18][19][20][21] The evacuation of deep intracerebral hemorrhage requiring conventional neuro-navigational software could be further optimized by using FPCT navigation techniques. Additionally, the ability to simultaneously perform endovascular intervention opens the door to true tandem procedures, (eg, stereotactic aspiration of an epidural hematoma and meningeal artery embolization).…”

Section: Discussionmentioning

confidence: 99%

Transcranial Access Using Fluoroscopic Flat Panel Detector CT Navigation

Cooke¹,

Levitt²,

Kim³

et al. 2010

AJNR Am J Neuroradiol

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SUMMARY:FPCT and navigation software on contemporary fluoroscopic units perform imaging of a quality comparable with conventional CT. They can accurately guide percutaneous procedures, providing live instrument visualization and the capability to re-image without patient transfer. FPCT navigation was used in the placement of a ventricular drain in a 62-year-old woman for subarachnoidrelated hydrocephalus by using an otherwise standard bedside technique. Ventriculostomy catheter placement was technically successful without complication with a catheter at the foramen of Monro.ABBREVIATIONS: DSA ϭ digital subtraction angiography; FPCT ϭ flat panel detector CT F PCT and integrated guidance software available on contemporary fluoroscopic systems emit a lower radiation dose while producing imaging of a quality comparable with that of conventional CT.1-5 They also have the ability to perform percutaneous procedures within the body, spine, and head and neck safely and accurately.4-11 FPCT demonstrates excellent spatial resolution and, though limited in subtle contrast differentiation, is of diagnostic accuracy in the assessment of general cerebral anatomy and higher attenuation features such as hemorrhage. [5][6][7][8]10,11 Beyond the ability of FPCTbased navigation to quickly and accurately target a particular focus is the provision of real-time instrument visualization using live fluoroscopic overlay and the capability of re-imaging without moving the patient, limitations of current neuronavigational programs. 10Ventricular drain catheter placement in the setting of subarachnoid hemorrhageϪrelated hydrocephalus is a common neurosurgical procedure. Performed at the bedside by using anatomic landmarks, ventriculostomy placement is safe and accurate with a low rate of complications.12-15 Given the frequent need for ventricular drain placement and the relative technical ease of the procedure, we chose it as means to demonstrate proof of principle regarding transcranial FPCT guidance. We herein describe the use of the navigation system in the placement of a ventriculostomy catheter. Case ReportA 62-year-old woman presented with altered mental status. Physical examination revealed an intubated obtunded patient with left-sided hemiplegia and equal and reactive pupils. CT of the head showed diffuse subarachnoid hemorrhage, hydrocephalus, and significant hemorrhage in the basal cisterns. CT angiography revealed a 6 ϫ 7 mm right-sided posterior communicating artery aneurysm and a 3 ϫ 2 mm left-sided middle cerebral artery aneurysm.The patient underwent emergent FPCT-guided ventriculostomy placement in the angiography suite. To minimize movement, we carefully taped her head to the table. The left scalp was prepped, and a 1-cm incision was made at the Kocher point, approximately 11 cm posterior to the glabella and 3 cm lateral to midline in the midpupillary line. A twist-drill craniostomy was performed. The dura and pia mater were cauterized and incised.Before catheter placement, an FPCT (XperCT and XperGuide; Philips Healthcare,...

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Section: Discussionmentioning

confidence: 99%

Transcranial Access Using Fluoroscopic Flat Panel Detector CT Navigation

Cooke¹,

Levitt²,

Kim³

et al. 2010

AJNR Am J Neuroradiol

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“…Stereotactic and endoscopic surgical evacuation of the intracerebral hematoma [56,57] or hemostatic agents [58] are being investigated. Intraparenchymal and intraventricular ultra low-dose thrombolytics to promote lysis of the hematoma are currently in phase II and III randomized clinical trials [59,60]. These interventions are all of potential therapeutic benefit in adults and, by extension, in children.…”

Section: Potential Treatments For Iphmentioning

confidence: 99%

Hemorrhagic Stroke in Children

Jordan

Hillis

2007

Pediatric Neurology

112

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Hemorrhagic stroke accounts for approximately half of stroke in childhood. Unlike arterial ischemic stroke, there are no consensus guidelines to assist in the evaluation and treatment of these children. We review the literature on the evaluation, treatment, etiology and neurologic outcome of hemorrhagic stroke in children. Important differences between pediatric and adult hemorrhage are highlighted, as treatment guidelines for adults may not be applicable in all cases. Needed future research and potential therapies are also discussed.

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“…It was still controversial for the effect of stereotactic aspiration of ICH (1,6,12,22). A famous trial named SICHPA (Stereotactic Treatment of Intracerebral Hematoma by means of a Plasminogen Activator) suggested that stereotactic aspiration was an effective operation to remove hematoma and improved the prognosis of patients (22).…”

Section: Discussionmentioning

confidence: 99%

“…Compared with craniotomy, the technique of less invasive clot aspiration means the less tissue trauma. If the procedure of operation were more refined and careful, the prognosis of patients rate of mortality and improve the long-term quality of life (1,5,7,9,24). However, many researchers hold the opposite view.…”

Section: Tang Zp Et Al: Modifying the Details Of Aspiration In Patiementioning

confidence: 99%

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Modifying the details of aspiration operation may contribute to the improvement of prognosis of patients with ICH

Tang

Shi²,

Yin³

et al. 2011

Turkish Neurosurgery

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AIm:The aim of the retrospective study was to compare the clinical efficacy of the traditional way of aspiration and the modified way of aspiration. mAterIAl and methOds: Clinical data of total 159 patients with spontaneous intracerebral hemorrhage treated by traditional (group A, n=66) or modified (group B, n=93) way of aspiration (both combined with thrombolysis) were retrospectively analyzed. Reduction of clot volume in the first operation, rate of mortality and re-bleeding, complications, and long-term clinical outcomes of the two groups were compared.results: Twenty-five out of 159 patients (15.7%) died during in-hospital stay. The mortality and post-operation re-bleeding rate in group B (10.8% and 1.1%) were significantly lower than that in group A (22.7% and 9.1%), (P<0.05). The BI scores of patients in group B (79.5±23.2) were significantly higher than that in group A (69.2±23.9), (P<0.05).COnClusIOn: Our data suggested that modifying details of aspiration operation may contribute to the improved prognosis of ICH patients.KeywOrds: Hematoma aspiration, Thrombolysis, Intracerebral hemorrhage, Outcome ÖZ AmAÇ: Retrospektif olarak yapılan bu çalışmada, klasik yol ile yapılan aspirasyon (Grup A) ile değiştirilmiş (modified) (Grup B) yöntemle yapılan aspirasyonun klinik etkinliği karşılaştırılmıştır. yÖntem ve GereÇ: Spontan intrakraniyal kanama geçiren 159 hasta retrospektif olarak iki ayrı grup halinde incelendi. İlk gruptaki 66 hastaya geleneksel yoldan aspirasyon yapılırken, 2. gruptaki 93 hastaya tromboliz yapılarak aspirasyon uygulanmıştır. Pıhtı hacmindeki azalma, mortalite hızı, yeniden kanama, komplikasyonlar ve geç dönem klinik sonuçları iki grupta karşılaştırılmıştır.BulGulAr: Toplam 159 hastadan, 25'i hastanede kaldıkları sürede öldü (%5,7). Mortalite hızı ve yeniden kanama hızı grup B'de (%10,8 ve %1,1grup A'ya (%22,7 ve %9,1) göre anlamlı şekilde düşük olarak bulundu (P<0,05). BI ölçütlemesi grup B'deki hastalarda (79,5±23,2), grup A'daki (69,2±23,9) hastalara göre anlamlı şekilde daha yüksek bulundu (P<0,05).sOnuÇ: İntrakraniyal kanaması olan hastalarda modifiye edilmiş aspirasyon yöntemi ile prognoz daha iyi hale gelebilmektedir.

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Frameless Stereotactic Aspiration and Thrombolysis of Spontaneous Intracerebral Hemorrhage

Cited by 73 publications

References 50 publications

Transcranial Access Using Fluoroscopic Flat Panel Detector CT Navigation

Transcranial Access Using Fluoroscopic Flat Panel Detector CT Navigation

Hemorrhagic Stroke in Children

Modifying the details of aspiration operation may contribute to the improvement of prognosis of patients with ICH

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