Abstract
Introduction: Intracerebral structures and pathologies such as intracerebral hemorrhages (ICH) can be displayed sufficiently by transcranial sonography (TCS). In some patients with ICH clot evacuation via surgery or catheter drainage to reduce secondary parenchymal injuries may be necessary. We hypothesized that bedside-placement of drainage-catheters, which is a minimal invasive evacuation-technique complicated by a higher rate of catheter misplacement can be optimized via TCS.Methods: Eleven consecutive ICH-patients diagnosed via computertomography (CT) were included in this prospective observational pilot study. All patients were examined via TCS, firstly in order to illustrate the hematoma, secondly to optimize catheter placement. Catheter placement was primarily validated via CT.Results: The TCS-depiction of ICH-extension was optimal in 10 patients; one patient showed a partially insufficient transtemporal bone window. Catheter positioning could be traced and adapted correctly via TCS-examination in all patients. Follow-up CT-scans confirmed TCS-description of catheter-positioning in all patients without any complications. Reduction of symptoms and ICH-volumes confirmed effectiveness of treatment.Conclusions: The illustration of ICH and the drainage-placement is possible via TCS in a cost- and time-efficient way.
Highlights
Intracerebral structures and pathologies such as intracerebral hemorrhages (ICH) can be displayed sufficiently by transcranial sonography (TCS)
The puncture site is selected based on computertomographic data with threedimensional planning but to date these techniques offer no concurrent visual control of catheter placement and are dependent on the neurosurgeons’ expertise [5, 6]
Eleven consecutive ICH-patients who were admitted to the Neurological Intensive Care Unit (NICU) of University Medical Center in Freiburg and in whom urgent evacuation of ICH was planned were included into this prospective observational pilot study
Summary
Intracerebral structures and pathologies such as intracerebral hemorrhages (ICH) can be displayed sufficiently by transcranial sonography (TCS). In some patients with ICH clot evacuation via surgery or catheter drainage to reduce secondary parenchymal injuries may be necessary. In cases of space-occupying hematoma or intraventricular hemorrhage surgical removal or catheter drainage may be crucial in order to reduce secondary injuries due to mass effects, hydrocephalus, excitotoxic stress, and perifocal edema [1,2,3,4]. In space-occupying ICH, minimally-invasive techniques, such as stereotactic or neuronavigation-assisted hematoma evacuation via catheters, have been developed as an alternative treatment to open hematoma evacuation and decompressive hemicraniectomy [2]. These procedures are time-consuming and are performed in an operating room. The puncture site is selected based on computertomographic data with threedimensional planning but to date these techniques offer no concurrent visual control of catheter placement and are dependent on the neurosurgeons’ expertise [5, 6]
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