A minimally invasive anterior skull base approach for evacuation of a basal ganglia hemorrhage

Dale Ding, Colin J. Przybylowski, Robert M. Starke, R. Sterling Street, Amber E. Tyree, R. Webster Crowley, Kenneth C. Liu

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

We describe the technical nuances of a minimally invasive anterior skull base approach for microsurgical evacuation of a large basal ganglia hematoma through an endoport. Patients who suffer from large spontaneous intracerebral hemorrhages (ICH) of the basal ganglia have a very poor prognosis. However, the benefit of surgery for the management of ICH is controversial. The development of endoport technology has allowed for minimally invasive access to subcortical lesions, and may offer unique advantages over conventional surgical techniques due to less disruption of the overlying cortex and white matter fiber tracts. A 77-year-old man presented with a hypertensive ICH of the right putamen, measuring 9 cm in maximal diameter and 168 cm3 in volume. We planned an endoport trajectory through the long axis of the hematoma using frameless stereotactic neuronavigation. In order to access the optimal cortical entry point at the lateral aspect of the basal frontal lobe, a miniature modified orbitozygomatic skull base craniotomy was performed through an incision along the superior border of the right eyebrow. Using the BrainPath endoport system (NICO, Indianapolis, IN, USA), the putaminal hematoma was successfully evacuated, resulting in an 87% postoperative reduction in ICH volume. Thus, we show that, in appropriately selected cases, endoport-assisted microsurgery is safe and effective for the evacuation of large ICH. Furthermore, minimally invasive anterior skull base approaches can be employed to expand the therapeutic potential of endoport-assisted approaches to include subcortical lesions, such as hematomas of the basal ganglia.

Original languageEnglish (US)
Pages (from-to)1816-1819
Number of pages4
JournalJournal of Clinical Neuroscience
Volume22
Issue number11
DOIs
StatePublished - Nov 2015

Fingerprint

Basal Ganglia Hemorrhage
Skull Base
Cerebral Hemorrhage
Putaminal Hemorrhage
Hypertensive Intracranial Hemorrhage
Neuronavigation
Eyebrows
Microsurgery
Craniotomy
Putamen
Frontal Lobe
Basal Ganglia
Hematoma
Technology

All Science Journal Classification (ASJC) codes

  • Surgery
  • Neurology
  • Clinical Neurology
  • Physiology (medical)

Cite this

Ding, D., Przybylowski, C. J., Starke, R. M., Sterling Street, R., Tyree, A. E., Webster Crowley, R., & Liu, K. C. (2015). A minimally invasive anterior skull base approach for evacuation of a basal ganglia hemorrhage. Journal of Clinical Neuroscience, 22(11), 1816-1819. https://doi.org/10.1016/j.jocn.2015.03.052
Ding, Dale ; Przybylowski, Colin J. ; Starke, Robert M. ; Sterling Street, R. ; Tyree, Amber E. ; Webster Crowley, R. ; Liu, Kenneth C. / A minimally invasive anterior skull base approach for evacuation of a basal ganglia hemorrhage. In: Journal of Clinical Neuroscience. 2015 ; Vol. 22, No. 11. pp. 1816-1819.
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Ding, D, Przybylowski, CJ, Starke, RM, Sterling Street, R, Tyree, AE, Webster Crowley, R & Liu, KC 2015, 'A minimally invasive anterior skull base approach for evacuation of a basal ganglia hemorrhage', Journal of Clinical Neuroscience, vol. 22, no. 11, pp. 1816-1819. https://doi.org/10.1016/j.jocn.2015.03.052

A minimally invasive anterior skull base approach for evacuation of a basal ganglia hemorrhage. / Ding, Dale; Przybylowski, Colin J.; Starke, Robert M.; Sterling Street, R.; Tyree, Amber E.; Webster Crowley, R.; Liu, Kenneth C.

In: Journal of Clinical Neuroscience, Vol. 22, No. 11, 11.2015, p. 1816-1819.

Research output: Contribution to journalArticle

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Ding D, Przybylowski CJ, Starke RM, Sterling Street R, Tyree AE, Webster Crowley R et al. A minimally invasive anterior skull base approach for evacuation of a basal ganglia hemorrhage. Journal of Clinical Neuroscience. 2015 Nov;22(11):1816-1819. https://doi.org/10.1016/j.jocn.2015.03.052