Introduction: Intracranial hemorrhage (ICH) is a highly prevalent disease associated with a high mortality (35-52%). Of the survivors, only 12 to 39 percent of patients will achieve independent function. The challenges associated with the surgical management of this entity fall into one of the following categories: mapping and imaging, access, visualization, and evacuation.
Methods: A systematic approach integrating 5 separate core competencies to provide safe and consistent minimally invasive corridors for evacuating ICH was created and includes:1) Imaging and mapping, 2) Dynamic navigation, 3) Radial transulcul access, 4) Exoscopic high definition optics, and 5) Resection with automated atraumatic mechanical instrumentation. The “5 pillars” approach was used for the surgical management of ten consecutive primary ICH admitted at the Ottawa Hospital between September 2011 and March 2013. Patients with suspected secondary ICH or uncorrected coagulopathy were excluded. Radiological and clinical data were retrospectively collected and analyzed.
Results: Complete evacuation of all ICH was confirmed radiologically. Diffusion tensor imaging (DTI) was used to confirm white matter tracts recovery. Significant recovery was observed in 78 % of the patients and no new deficits were encountered. There were no systemic complications or fatalities.
Conclusions: The “5 pillars” approach is safe and effective for the management of primary ICH.
Patient Care: Significantly improve the functional outcome of patients after ICH by early evacuation of the hemorrhage with minimal collateral damage to both cortical and subcortical normal tissue.
Learning Objectives: Understand how multiple new technologies can be used to systematically approach deep-seated with minimal collateral damage.