Abstract W MP120: Minimally invasive subcortical parafascicular access for clot evacuation. A paradigm shift


Aurora St. Luke's Medical Center


Introduction: Spontaneous intracerebral hemorrhage (ICH) is common and causes significant mortality and morbidity. To date, intervention remains uncertain. Neurosurgical therapies for subcortical lesions have been limited by procedure-related injury to the cerebral cortex and adjacent subcortical brain regions. This is particularly relevant for eloquent cortex, therefore surgical therapy is often not performed.

Hypothesis: We hypothesized that using an integrated systems approach for Minimally invasive Subcortical Parafascicular Access for Clot Evacuation (MiSPACE) consistently, could result in improved clinical outcomes and protection of eloquent tissue, especially if we focus on minimizing trauma to normal tissue.

Methods: We report on this standardized technique incorporating 5 cores of MiSPACE 1) image interpretation and trajectory planning, 2) dynamic navigation, 3) a traumatic access (BrainPath, NICO Corp), 4) optics (Storz), and 5) resection (Myriad, NICO, Corp), wherein all surgeons have been trained through a CME course and have applied the surgical technique and approach in all 25 cases. Pathology, pre- and post-operative clinical and radiographic characteristics and clinical outcome at last follow-up were collected.

Results and Conclusions: The cases presented illustrate successful application of the MiSPACE standardized systems approach. Mean pre-operative ICH volume was 47.2 and mean percentage of clot removal was 89%. Most importantly, significant recovery was observed in 89% of patients with no new deficits reported. MRI tractography obtained pre operatively illustrates how collateral tissue preservation can be achieved by trajectory planning. Using the same technique, the same equipment, in a standardized approach in dominant, eloquent cortex and subcortical regions (Table 1) this may lead to improved outcomes. Safety and feasibility studies are required to further assess this promising new therapeutic paradigm.

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