Authors: Jefferson W. Chen, MD, PhD, FAANS; Diem Kieu Tran, MD; Francisco Soldevilla, MD; Laurence Dickinson, MD; David Adler, MD (Orange, CA)
Controversy exists as to whether or not there is a role for Neurosurgical Intervention to remove traumatic intracerebral hemorrhages(tICH). In addition to the underlying traumatic brain injury, the tICH elicits an inflammatory response that leads to significant cerebral edema and mass effect. This may be exacerbated by neurosurgical manipulation. The recent development of Minimally Invasive Parafascular Surgery(MIPS) has shown great promise in decreasing collateral damage from the neurosurgical removal of intracerebral hemorrhages. We present a multi-center experience using MIPS to remove tICH.
This was a retrospective study involving three Level-1 Trauma Centers. Cases where MIPS techniques were used were identified. A tubular retractor system was used in most of these cases. Information extracted included patient age, mechanism of injury, pre-operative GCS, post-operative GOS, pre- and post-operative hemorrhage volumes, hospital course, and location of the tICH.
Ten patients were identified from 1/2015-6/2018 that had undergone MIPS for the removal of the tICH. The average age was 52.2+/-20, the M:F=7:3, the average pre-operative tICH volume = 29.8+/-14cc, the post-resection volume=1.3 +/-1.0cc. The average presenting GCS=9.6+/-2.75, the average GOS=4.6. Average hospital length of stay post-surgery=8.8+/-7 days. Eight of the MIPS were done on subfrontal tICH, one on a Basal Ganglia tICH, one on a right Temporal hemorrhage. 8/10 cases were the result of a ground level fall, 2 were the result of motor vehicle crashes. The average time to surgery was post-injury day 3.5.
MIPS techniques may be used effectively and safely to remove deep subcortical hemorrhages. The attenuation of the peri-hematoma cerebral edema by these interventions may improve the patient's hospital course and ultimate neurolgical outcome.