J Cerebrovasc Endovasc Neurosurg.  2017 Jun;19(2):101-105. 10.7461/jcen.2017.19.2.101.

Eyebrow Incision for Surgical Evacuation of a Lobar Intracerebral Hematoma with a Novel Endoport System

• Ding D
• Przybylowski CJ
• Starke RM
• Crowley RW
• Liu KC

• KMID: 2393387
• DOI: http://doi.org/10.7461/jcen.2017.19.2.101

Abstract

Large lobar intracerebral hemorrhages (ICHs) can cause rapid neurological deterioration, and affected patients have low rates of survival and functional independence. Currently, the role of surgical intervention in the management patients with lobar ICHs is controversial. Minimally invasive technologies have been developed which may potentially decrease the operative morbidity of ICH surgery. The aim of this case report is to describe the technical aspects of the use of a novel minimally invasive endoport system, the BrainPath (NICO, Indianapolis, IN, USA), through an eyebrow incision for evacuation of a large lobar hematoma. An 84-year-old female presented with a left frontal ICH, measuring 7.5 cm in maximal diameter and 81 cm³ in volume, secondary to cerebral amyloid angiopathy. Through a left eyebrow incision, a miniature modified orbitozygomatic craniotomy was performed, which allowed endoport cannulation of the hematoma from a lateral subfrontal cortical entry point. Endoport-assisted hematoma evacuation resulted in nearly 90% volume reduction and improvement of the patient's functional status at clinical follow-up. We found that minimally invasive endoport technology can be employed in conjunction with conventional neurosurgical skull base principles to achieve safe and effective evacuation of large lobar hematomas in carefully selected patients.

Keyword

Cerebral amyloid angiopathy; Endoport; Intracranial hemorrhages; Microsurgery; Minimally invasive; Stroke

MeSH Terms

Aged, 80 and over
Catheterization
Cerebral Amyloid Angiopathy
Cerebral Hemorrhage
Craniotomy
Eyebrows*
Female
Follow-Up Studies
Hematoma*
Humans
Intracranial Hemorrhages
Microsurgery
Skull Base
Stroke

Figure

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  Fig. 1 (A) Preoperative brain CT, axial view, shows a large left frontal ICH measuring 7.5 × 4.3 × 5.0 cm (volume 80.6 cm3) with intraventricular extension, and resulting in a midline shift of 6.7 mm. The ICH was evacuated through a left eyebrow incision and mini-mOZ craniotomy using the BrainPath endoport system. Postoperative brain CT, (B) 3D reconstruction, shows the mini-OZ craniotomy and, (C) axial view, shows a 4.9 × 1.7 × 2.5 cm residual ICH (volume 10.4 cm3, 87% volume reduction), with significant reduction in midline shift and local mass effect. CT = computed tomography; ICH = intracerebral hemorrhage.

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