Decreasing the Cerebral Edema Associated with Traumatic Intracerebral Hemorrhages: Use of a Minimally Invasive Technique

Acta Neurochir Suppl. 2016;121:279-84. doi: 10.1007/978-3-319-18497-5_48.


Traumatic brain injury (TBI) is a major public health problem worldwide that affects all age groups. In the United States alone, there are approximately 50,000 deaths from severe traumatic brain injuries each year. In most studies, about 40 % of severe TBI have associated traumatic intracerebral hemorrhages (tICHs). The surgical treatment of tICH is debated largely because of its invasive nature, particularly in reaching deep tICHs. tICHs have a clear contribution to mass effect and exacerbate cerebral edema and ICP because of the break-down products of hemorrhage. We introduce a modification of the Mi SPACE technique (Minimally Invasive Subcortical Parafascicular Transsulcal Access for Clot Evacuation) that is applicable to tICH. In brief, this technique utilizes a trans-sulcal, stereotactic-guided technique in which a specially designed cannula is used to introduce a 13.5-mm-diameter tube into the epicenter of the tICH. We identified eight tICHs that were treated entirely or in part with the modified Mi SPACE technique during the time period from August 15, 2014 to December 15, 2014. This modified technique was readily deployed safely and efficaciously with significant removal of the tICH as demonstrated by postoperative CT scans. The removal of tICH using this minimally invasive technique may help with the control of ICP and cerebral edema.

Keywords: BrainPath; Cerebral edema; Intracranial pressure (ICP); Mi SPACE (Minimally Invasive Subcortical Parafascicular Transsulcal Access for Clot Evacuation); Traumatic brain injury (TBI); Traumatic intracerebral hemorrhage (tICH).

MeSH terms

  • Accidental Falls
  • Accidents, Traffic
  • Adult
  • Aged
  • Brain Edema / diagnostic imaging
  • Brain Edema / etiology
  • Brain Edema / surgery*
  • Cerebral Hemorrhage, Traumatic / complications
  • Cerebral Hemorrhage, Traumatic / diagnostic imaging
  • Cerebral Hemorrhage, Traumatic / surgery*
  • Craniotomy
  • Drainage / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures / methods*
  • Neuronavigation
  • Neurosurgical Procedures / methods*
  • Retrospective Studies
  • Stereotaxic Techniques
  • Tomography, X-Ray Computed
  • Violence