Document Detail


Near-real-time guidance using intraoperative magnetic resonance imaging for radical evacuation of hypertensive hematomas in the basal ganglia.
MedLine Citation:
PMID:  11063100     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To report our preliminary clinical experience in treating patients with hypertensive hemorrhage in the basal ganglia using a minimally invasive approach facilitated by intraoperative real-time imaging of an open magnetic resonance imaging (MRI) system and a newly designed cutting suction device. METHODS: We developed an artifact-free device for use during intraoperative MRI consisting of a guiding base that locks into a burr hole, a side-cutting composite-based cannula connected to a standard aspirator, and a handpiece that allows aspiration strength to be regulated by the surgeon. Thirteen patients with hypertensive bleeding in the basal ganglia were included in the study. Outcome was evaluated by mortality, Glasgow Outcome Scale score, activities of daily living score, and Rankin score at 2 weeks and at a median of 4.2 months after the hemorrhage. RESULTS: In this group of 13 patients, complete evacuation was achieved in 8 patients (62%) and subtotal evacuation of 75 to 90% of the initial volume in 4 patients (31%); the evacuation was partial in 1 patient (8%). Vascular malformations were preoperatively excluded angiographically. There was no rebleeding during surgery or postoperatively, as demonstrated by immediate postoperative MRI and computed tomography on the 1st postoperative day. Hematomas were evacuated on median Day 4 after the hemorrhage, varying between Day 1 and Day 8; evacuation was performed on Day 21 after the hemorrhage in one patient. Twelve of the 13 patients survived during a median follow-up time of 4.2 months. Neurological function improved in 11 of the 12 patients eligible for assessment. One patient with an additional head injury died 15 days after surgery from pulmonary embolism. CONCLUSION: This study shows an excellent outcome with regard to mortality and a positive trend regarding neurological outcome for the specific group of patients with hypertensive hematomas in the basal ganglia. This minimally invasive approach is feasible in the open intraoperative MRI in combination with the cutting suction device developed in our institution. Online imaging is extremely helpful for planning, guiding, and real-time monitoring of the procedure.
Authors:
R L Bernays; S S Kollias; B Romanowski; A Valavanis; Y Yonekawa
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  47     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  2000 Nov 
Date Detail:
Created Date:  2001-03-22     Completed Date:  2001-05-31     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1081-9; discussion 1089-90     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, University Hospital of Zürich, Switzerland. bernays@nch.unizh.ch
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Basal Ganglia Diseases / pathology*,  radiography,  surgery*
Equipment Design
Female
Follow-Up Studies
Glasgow Coma Scale
Hematoma / pathology*,  radiography,  surgery*
Humans
Hypertension
Magnetic Resonance Imaging*
Male
Middle Aged
Monitoring, Intraoperative*
Neurosurgical Procedures / instrumentation,  methods*
Retrospective Studies
Surgical Procedures, Minimally Invasive
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Comments/Corrections
Comment In:
Neurosurgery. 2001 Aug;49(2):478   [PMID:  11504131 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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