• World Neurosurg · Feb 2021

    Review Case Reports

    Combined decompressive hemicraniectomy (DHC) and port-based minimally-invasive parafascicular surgery (MIPS) for the treatment of subcortical intracerebral hemorrhage: Case series, Technical Note, and Review of Literature.

    • Srikant S Chakravarthi, Leah Lyons, Andres Restrepo Orozco, Leonard Verhey, Paul Mazaris, Joseph Zacharia, and Justin A Singer.
    • Department of Neurosurgery, Department of Clinical Neurosciences, Spectrum Health, Grand Rapids, Michigan, USA.
    • World Neurosurg. 2021 Feb 1; 146: e1226-e1235.

    BackgroundIntracerebral hemorrhage (ICH) is a neurosurgical emergency. Combined decompressive hemicraniectomy (DHC) and minimally invasive parafascicular surgery (MIPS) may provide a practical method of managing subcortical ICH.Objective1) To present a case series of combined DHC-MIPS for the treatment of subcortical-based ICH; 2) to describe technical nuances of DHC-MIPS; and 3) to provide a literature overview of MIPS for ICH.MethodsThe following inclusion criteria were used: 1) Glasgow Coma Scale (GCS) score <3-4; 2) admission within 6 hours of onset; 3) increased intracranial pressure caused by hemorrhage; 4) patient unresponsive to medical management; 5) hemorrhage >30 cm3; 6) subcortical location; and 7) midline shift (mm). Before DHC, sulcal cannulation used the following coordinates: intersection of tragus-frontal bone and midpoint of midpupillary line and midline; coronal suture: 3-4 cm posterior to this point).ResultsThree patients were selected: a 62-year old woman, a 45-year old woman, and a 36-year-old man. GCS and ICH scores on admission were 7 and 3, 3 and 4, and 3 and 4, respectively. ICH was located in left basal ganglia in patients 1 and 3 and right basal ganglia in patient 2, all with intraventricular extension. ICH volume was 81.7, 68.2, and 42.3 cm3, respectively. The postoperative GCS score was 11, 10, and 6, respectively. There were no intraoperative complications or mortalities. Evacuation was within 15 minutes in all patients. The modified Rankin Scale score was 3, 4, and 5, respectively, with semi-independence in case 1.ConclusionsCombined DHC-MIPS, with the use of craniometric points, can provide a unique and simple surgical option for the management of subcortical ICH.Copyright © 2020 Elsevier Inc. All rights reserved.

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