1 / 17

I ntraoperative C T guided E ndoscopic S urgery for Intracerebral Hemorrhage (ICES)

I ntraoperative C T guided E ndoscopic S urgery for Intracerebral Hemorrhage (ICES). Paul M. Vespa, MD Neil Martin, MD Jennifer Varma, RN, NP UCLA ICES Surgical Center Dan Hanley,MD PI MISTIE/ICES Coordinating Center Johns Hopkins. Experimental Procedure.

luana
Download Presentation

I ntraoperative C T guided E ndoscopic S urgery for Intracerebral Hemorrhage (ICES)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Intraoperative CT guided Endoscopic Surgery for Intracerebral Hemorrhage (ICES) Paul M. Vespa, MD Neil Martin, MD Jennifer Varma, RN, NP UCLA ICES Surgical Center Dan Hanley,MD PI MISTIE/ICES Coordinating Center Johns Hopkins

  2. Experimental Procedure • Initial Screen, Estimation of clot size (cc) • Prepare for OR, plan trajectory, • Call Dr. Martin • Stereotactic placement of burr hole • Stereoactic trajectory for endoscope • Suction of hematoma (start at 50 mm Hg) • Measurement of extracted clot volume (cc) • Hemostasis • Placement of hematoma drain • Repeat imaging • CT Post-op, CT Days 1-4, MRI day 7

  3. Graduated Suction

  4. Registry case (05-S06) • 75 year-old female • History of meningioma, s/p resection and radiation therapy in 1999 • Restrained driver involved in MVA, noted to be driving erratically before hitting another vehicle • Upon examination by EMS, found to have left-sided arm and leg weakness • Initial head CT demonstrated large right-sided hematoma, estimated at about 50 cc

  5. CT on arrival:

  6. Registry Case • Screened for ICES, determined to be a good candidate • Informed consent obtained • CTA performed and did not show evidence of an aneurysm or vascular malformation • Stability CT showed no further extension of the hematoma • Patient to OR approximately < 12 hours following initial CT

  7. Pre-op OR Screen Shots (BrainLAB):

  8. Operative Procedure • Right parietal burr hole • Initial depth 9 cm, suctioned up to 300 mm Hg, no clot obtained • Repositioned endoscope to a depth of 7 cm, suctioned up to 300 mm Hg and 32 cc of clot obtained; about a 60% clot reduction • Bleeding vessels controlled with monopolar and DDAVP infusion • Hematoma catheter left in place

  9. Post-op CT:

  10. Additional Post-op Image:(catheter placement)

  11. Post-op BrainLAB screen shots:(yellow – preop, orange – postop)

  12. MRI – to be done on day 7

  13. Key Points • Surgical Planning with Dr. Martin • Steps in protocol with documentation in OR • Database documentation of ICU days • Serial Imaging: CT daily x 4 days, MRI at day 7 • Submit registry cases for review to the coordinating center and surgical center

More Related