Use of the Image Guided Minimally Invasive BrainPath System to Evacuate Spontaneous Cerebellar Hemorrhages.

Kainaat Javed,Neil Haranhalli,David J Altschul,Adam Ammar,Ryan Holland,Mousa K Hamad,Phillip C Cezayirli,Adisson N Fortunel

doi:10.7759/cureus.16124

Abstract

BrainPath (NICO, Indianapolis, Indiana) is a tool that can be used to evacuate supratentorial hematomas due to spontaneous intracerebral hemorrhage (ICH). However, when ICH occurs in the posterior fossa, an open approach is often undertaken to evacuate the hematoma. The application of minimally invasive technology, while available, has not been well established. Our objective was to describe the use of the image-guided, minimally invasive BrainPath system to evacuate a spontaneous cerebellar hemorrhage. We present the case of a sixty-four-year-old male patient with a cerebellar hematoma due to hypertensive hemorrhage. The patient's medical record, including the history and physical, progress notes, operative notes, discharge summary, and imaging studies were reviewed to document the clinical presentation as well as the details of the operative technique and postoperative outcomes in this paper. We discuss the technical nuances of the operative points in detail. In our example case, the BrainPath system was successfully used to evacuate the cerebellar hematoma and no procedural-related complications occurred. The patient's recovery remained uncomplicated at three months of follow-up. In summary, the BrainPath system offers a less invasive alternative to open evacuation for cerebellar bleeds.

Highlights

There has been renewed interest in the surgical management of intracerebral hemorrhage (ICH) using minimally invasive approaches
The results from the minimally invasive surgery plus recombinant tissue plasminogen activator for ICH evacuation phase III (MISTIE-III) trial showed no functional benefit to surgical intervention, subgroup analyses did show a potential subset of patients that might have improvement with surgical evacuation [1]
The MISTIE technique is somewhat cumbersome given the requirement for injection of tissue plasminogen activator post-procedure

Summary

Introduction

There has been renewed interest in the surgical management of intracerebral hemorrhage (ICH) using minimally invasive approaches. The results from the minimally invasive surgery plus recombinant tissue plasminogen activator (rt-PA) for ICH evacuation phase III (MISTIE-III) trial showed no functional benefit to surgical intervention, subgroup analyses did show a potential subset of patients that might have improvement with surgical evacuation [1]. Other more reasonable minimally invasive techniques such as image-guided endoscopic techniques and exoscopic-guided hematoma evacuation may achieve more immediate results with a less invasive approach, without the requirement of a long-term catheter in the clot cavity. The BrainPath (NICO, Indianapolis, IN) system is one example of a technique that utilizes an exoscope or microscope and tubular retraction system to evacuate deep-seated hematomas with minimal trauma to white matter tracts. The use of the BrainPath system has been described in the literature and is shown to be safe, effective, and associated with functional independence [2]

Objectives

Discussion

Conclusion