Introduction: We describe 2 innovative MIS, combining fascicular anatomy and advanced imaging. Hypothesis is MIS results in decreased clot burden, restoration fascicular anatomy and improved survival.
Methods: 53 subjects, ICH 20cc-90cc, age <80, and admission GCS >5 selected from 855 consecutive SC-ICH. Cohort of 32 ICH 20cc-60cc, a modified 14Fr urethral rubber catheter (Bard Inc.) was image guided (StealthStation® AxiEM™) along the long axis of the ICH and evacuated by manual aspiration followed rtPA lysis and drainage. Second cohort of 21 ICH 40cc-90cc: 12mm port (VBAS™, Vycor Medical Inc.) image guided for microsurgical evacuation. Cohorts followed with CT/MRI.
Results: First cohort: mean surgical reduction of 26cc (p<0.05). At 24 hours, mean 13cc after rtPA lysis (p<0.05). 30 day mortality 10.5% (40% by predicted ICH scores). Admission GCS of 9.8 and 12.1 at discharge (p=0.0053).
Second cohort: 80% reduction (pre 82.6cc +/- 21.8, post 16.9cc +/- 12.9). Mortality: 50% (expected 50.5 +/- 28.3%). T2-FLAIR: minimal injury to longitudinal tracts. Effect on cortico-spinal tract anatomy will be demonstrated by DTI. Will discuss operative nuances to achieve maximal evacuation.
Conclusions: Innovative MIS for SC-ICH is feasible, effective, without significant disruption of subcortical tracts. DTI demonstrates trend towards preservation of cortico-spinal tract.
Patient Care: MIS for spontaneous ICH is being tested in a Phase III trial (MISTIE III). If shown to be efficacious, innovative minimally invasive techniques could be potential additions to our surgical armamentarium.
Learning Objectives: Applications novel surgical techniques using fascicular anatomy, imagine guidance and lessons learned from previous clinical trials to the treatment of subcortical spontaneous hemorrhages.