402 Minimally Invasive Parafasicular Surgery for Hemorrhagic Stroke. First Experience. From January 2018 to December 2022. Panama

Abstract

INTRODUCTION: Hemorrhagic stroke represents 10-15% of all strokes, with a mortality of 40% and independence of 25% at six months, and represents a significant burden for public health. Minimally invasive surgery (MIS) methods through parafasicular approaches are a new option. METHODS: A prospective study from January 2018 to December 2020. The evaluation includes age, gender, comorbidities, GCS, and mRS scales. CT was the only form of imaging, establishing size, signs of intracranial hypertension, hydrocephalus, intraventricular bleeding, and surgical planning. The craniotomy is done through craniometrics points, and employing a tubular port for the parafasicular approach was done within the first 24 hours. The ultrasound, microscope, and endoscope were used. The objective was the reduction of the hematoma to less than 15cc. The postoperative period was semi-intensive. RESULTS: 25 patients were included, mean age 56 years, 56% men and 44% women. Location: 5 frontal, 18 basal nuclei, and 2 temporal. 60% left. 32% intraventricular extension. The average ICH Score was 1.84. The average volume was 50 cc. Mean GCS of 10 and mean mRS of 4. The mean ICH reduction was 95%, and the mean residual volume was 2.4cc. Not deceased. A reoperation. Larger ICH and intraventricular hemorrhage had a worse outcome (p = 0.01 and p = 0.04). Higher ICH Scores were associated with a worse outcome than those with a lower score (2.4 vs. 1.5; p = 0.008). Average follow-up of 4 months. Mean mRS at the discharge of 4 and the follow-up of 3 GCS in the follow-up of 14. CONCLUSIONS: MIP surgery reduces the size of the hematoma, improves the quality of life, and is safe.