Identifying Predictors of Initial Surgical Failure during Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation

被引:2
作者
Baker, Turner [1 ,2 ]
Kalagara, Roshini [1 ,2 ]
Hashmi, Ayesha [1 ,2 ]
Rodriguez, Benjamin [1 ,2 ]
Liu, Shelley [3 ]
Mobasseri, Hana [3 ]
Smith, Colton [2 ]
Rapoport, Benjamin [1 ,2 ]
Costa, Anthony [1 ,2 ]
Kellner, Christopher [2 ]
机构
[1] Icahn Sch Med Mt Sinai, Sinai BioDesign, New York, NY 10029 USA
[2] Icahn Sch Med Mt Sinai, Dept Neurosurg, New York, NY 10029 USA
[3] Icahn Sch Med Mt Sinai, Dept Populat Hlth Sci & Policy, New York, NY 10029 USA
关键词
intracerebral hemorrhage; intraoperative MRI; stroke; minimally invasive surgery; hemorrhage; SURGERY;
D O I
10.3390/biomedicines12030508
中图分类号
Q5 [生物化学]; Q7 [分子生物学];
学科分类号
071010 ; 081704 ;
摘要
Background and Purpose: Intracerebral hemorrhage (ICH) is a common and severe disease with high rates of morbidity and mortality; however, minimally invasive surgical (MIS) hematoma evacuation represents a promising avenue for treatment. In February of 2019, the MISTIE III study found that stereotactic thrombolysis with catheter drainage did not benefit patients with supratentorial spontaneous ICH but that a clinical benefit may be present when no more than 15 mL of hematoma remains at the end of treatment. Intraoperative CT (iCT) imaging has the ability to assess whether or not this surgical goal has been met in real time, allowing for operations to add additional CT-informed 'evacuation periods' (EPs) to achieve the surgical goal. Here, we report on the frequency and predictors of initial surgical failure on at least one iCT requiring additional EPs in a large cohort of patients undergoing endoscopic minimally invasive ICH evacuation with the SCUBA technique. Methods: All patients who underwent minimally invasive endoscopic evacuation of supratentorial spontaneous ICH in a major health system between December 2015 and October 2018 were included in this study. Patient demographics, clinical and radiographic features, procedural details, and outcomes were analyzed retrospectively from a prospectively collected database. Procedures were characterized as initially successful when the first iCT demonstrated that surgical success had been achieved and initially unsuccessful when the surgical goal was not achieved, and additional EPs were performed. The surgical goal was prospectively identified in December of 2015 as leaving no more than 20% of the preoperative hematoma volume at the end of the procedure. Descriptive statistics and regression analyses were performed to identify predictors of initial failure and secondary rescue. Results: Patients (100) underwent minimally invasive endoscopic ICH evacuation in the angiography suite during the study time period. In 14 cases, the surgical goal was not met on the first iCT and multiple Eps were performed; in 10 cases the surgical goal was not met, and no additional EPs were performed. In 14 cases, the surgical goal was never achieved. When additional EPs were performed, a rescue rate of 71.4% (10/14) was seen, bringing the total percentage of cases meeting the surgical goal to 86% across the entire cohort. Cases in which the surgical goal was not achieved were significantly associated with older patients (68 years vs. 60 years; p = 0.0197) and higher rates of intraventricular hemorrhage (34.2% vs. 70.8%; p = 0.0021). Cases in which the surgical goal was rescued from initial failure had similar levels of IVH, suggesting that these additional complexities can be overcome with the use of additional iCT-informed EPs. Conclusions: Initial and ultimate surgical failure occurs in a small percentage of patients undergoing minimally invasive endoscopic ICH evacuation. The use of intraoperative imaging provides an opportunity to evaluate whether or not the surgical goal has been achieved, and to continue the procedure if the surgeon feels that more evacuation is achievable. Now that level-one evidence exists to target a surgical evacuation goal during minimally invasive ICH evacuation, intraoperative imaging, such as iCT, plays an important role in aiding the surgical team to achieve the surgical goal.
引用
收藏
页数:11
相关论文
共 50 条
[31]   Minimally Invasive Intracerebral Hemorrhage Evacuation Improves Pericavity Cerebral Blood Volume [J].
Colton J. Smith ;
Christina P. Rossitto ;
Michael Manhart ;
Imke Fuhrmann ;
Julie DiNitto ;
Turner Baker ;
Muhammad Ali ;
Marily Sarmiento ;
J Mocco ;
Christopher P. Kellner .
Translational Stroke Research, 2024, 15 :599-605
[32]   Identifying the Specific Subtype of Intracerebral Hemorrhage that is Indicated for Minimally Invasive Craniopuncture [J].
Wanbing Jia ;
Biao Zhao ;
Jinghua Du ;
Guofeng Wu ;
Tingzhong Wang .
Neurocritical Care, 2020, 33 :670-678
[33]   Description of Pericavity Edema in Patients With Intracerebral Hemorrhage Who Have Undergone Endoscopic Minimally Invasive Evacuation [J].
Horowitz, Maxwell E. ;
Allen, Olivia ;
Chartrain, Alex G. ;
Glassberg, Brittany ;
Sakai, Yu ;
Turkheimer, Lena ;
Mocco, J. ;
Kellner, Christopher P. .
STROKE, 2018, 49
[34]   Safety of Endoscopic Surgery for Spontaneous Intracerebral Hemorrhage in the Registry of Intracerebral Hemorrhage Treated by Endoscopic Hematoma Evacuation in Japan [J].
Yamamoto, Takuji ;
Watabe, Takeya ;
Yamashiro, Shigeo ;
Tokushige, Kazuo ;
Nakajima, Nobuyuki ;
Arakawa, Yoshiki ;
Mine, Yutaka .
WORLD NEUROSURGERY, 2024, 189 :e370-e379
[35]   New approach of minimally invasive evacuation for spontaneous supratentorial intracerebral hemorrhage [J].
Cai, Qiang ;
Wang, Wenju ;
Li, Zhiyang ;
Song, Ping ;
Zhou, Long ;
Cheng, Li ;
Wei, Hangyu ;
Lei, Pan ;
Chen, Qianxue ;
Yang, Zhaohui .
AMERICAN JOURNAL OF TRANSLATIONAL RESEARCH, 2022, 14 (03) :1969-1978
[36]   Early minimally invasive intracerebral hemorrhage evacuation: a phase 2a feasibility, safety, and promise of surgical efficacy study [J].
Kleinig, Timothy J. ;
Abou-Hamden, Amal ;
Laidlaw, John ;
Churilov, Leonid ;
Kellner, Christopher Paul ;
Wu, Teddy ;
Mocco, J. ;
Lau, Hui ;
Adamides, Alexios ;
Kavar, Bhadrakant ;
Dimou, James ;
Cranefield, Jennifer ;
McDonald, Amy ;
Plummer, Stephanie ;
Davis, Stephen ;
Campbell, Bruce C., V .
JOURNAL OF NEUROINTERVENTIONAL SURGERY, 2024, 16 (06) :555-558
[37]   Catheter Placement and Surgical Training in the Minimally Invasive Surgery Plus rt-PA for Intracerebral Hemorrhage Evacuation Trial [J].
Ullman, Natalie L. ;
Muschelli, John ;
Li, Matthew ;
Morgan, Timothy C. ;
Awad, Issam A. ;
Zuccarello, Mario ;
Lane, Karen ;
Hanley, Daniel F. .
STROKE, 2013, 44 (02)
[38]   Intraoperative CT and cone-beam CT imaging for minimally invasive evacuation of spontaneous intracerebral hemorrhage [J].
Nils Hecht ;
Marcus Czabanka ;
Paul Kendlbacher ;
Julia-Helene Raff ;
Georg Bohner ;
Peter Vajkoczy .
Acta Neurochirurgica, 2020, 162 :3167-3177
[39]   Intraoperative CT and cone-beam CT imaging for minimally invasive evacuation of spontaneous intracerebral hemorrhage [J].
Hecht, Nils ;
Czabanka, Marcus ;
Kendlbacher, Paul ;
Raff, Julia-Helene ;
Bohner, Georg ;
Vajkoczy, Peter .
ACTA NEUROCHIRURGICA, 2020, 162 (12) :3167-3177
[40]   Predictors of Surgical Intervention in Patients with Spontaneous Intracerebral Hemorrhage [J].
Chen, Ching-Jen ;
Ding, Dale ;
Lronside, Natasha ;
Buell, Thomas J. ;
Southerland, Andrew M. ;
Woo, Daniel ;
Worrall, Bradford B. .
WORLD NEUROSURGERY, 2019, 123 :E700-E708