Use of 11 mm BrainPath endoport in minimally invasive hematoma evacuation: A case report

Abstract

Background: Intracranial hemorrhage (ICH) results in devastating neurological injury as a result of both mass effect and the pro-inflammatory response to erythrolysis. Minimally invasive surgical techniques for hematoma evacuation are promising for improving functional outcome. The NICO BrainPath 13.5 mm tubular retractor system has been used as a minimally invasive approach to subcortical intracranial hemorrhages. Here we report the first ever use of the novel 11 mm BrainPath retractor system to evacuate a subcortical intracerebral hematoma.Case Description: 52 year-old man presented to our hospital with expanding left basal ganglia hemorrhage and declining neurological exam. The patient underwent minimally invasive NICO (Indianapolis, IN) BrainPath evacuation using an 11 mm tubular retractor system. Near total evacuation was successfully achieved. The patient did well postoperatively, with a favorable 90-day functional outcome. Conclusion: In this case, using an 11 mm NICO (Indianapolis, IN) BrainPath system for basal ganglia ICH provided early, near-total hematoma evacuation and favorable functional outcome at 90-day check-in. Here, we demonstrate the technical feasibility of utilizing an 11 mm BrainPath tubular retractor instead of the traditional 13.5 mm system for evacuating ICH. It is the hope that the smaller 11 mm access port more closely matches endoscopic evacuation access techniques and could potentially mitigate the impact of a MIS approach on surrounding parenchyma while still achieving optimal evacuation.

Keywords

• Intracranial hemorrhage
• Minimally invasive neurosurgery
• BrainPath
• Subcortical hemorrhage
• Case report