Minimally Invasive Subcortical Parafascicular Transsulcal Access for Clot Evacuation (Mi SPACE) for Intracerebral Hemorrhage

Benjamin Ritsma, Amin Kassam, Dariush Dowlatshahi, Thanh Nguyen, Grant Stotts, Benjamin Ritsma, Amin Kassam, Dariush Dowlatshahi, Thanh Nguyen, Grant Stotts

Abstract

Background. Spontaneous intracerebral hemorrhage (ICH) is common and causes significant mortality and morbidity. To date, optimal medical and surgical intervention remains uncertain. A lack of definitive benefit for operative management may be attributable to adverse surgical effect, collateral tissue injury. This is particularly relevant for ICH in dominant, eloquent cortex. Minimally invasive surgery (MIS) offers the potential advantage of reduced collateral damage. MIS utilizing a parafascicular approach has demonstrated such benefit for intracranial tumor resection. Methods. We present a case of dominant hemisphere spontaneous ICH evacuated via the minimally invasive subcortical parafascicular transsulcal access clot evacuation (Mi SPACE) model. We use this report to introduce Mi SPACE and to examine the application of this novel MIS paradigm. Case Presentation. The featured patient presented with a left temporal ICH and severe global aphasia. The hematoma was evacuated via the Mi SPACE approach. Postoperative reassessments showed significant improvement. At two months, bedside language testing was normal. MRI tractography confirmed limited collateral injury. Conclusions. This case illustrates successful application of the Mi SPACE model to ICH in dominant, eloquent cortex and subcortical regions. MRI tractography illustrates collateral tissue preservation. Safety and feasibility studies are required to further assess this promising new therapeutic paradigm.

Figures

Figure 1
Figure 1
Intraoperative images depicting (a) the Mi SPACE computer assisted navigation system and the radial access transsulcal corridor system, BrainPath (BP) (NICO corp., Indianapolis, Indiana), (b) BrainPath (BP), and (c) the small craniotomy site and dime-sized dural opening created along the predefined sulcus for an entry point. A narrow dural opening allows for a tight seal against the edges of the BP.
Figure 2
Figure 2
Color coded fractional anisotropy (FA) maps obtained from the diffusion-tensor imaging (DTI) show collateral tissue preservation, with only small areas of decrease in FA in the left inferior longitudinal fasciculus (long arrow).

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Source: PubMed

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