Combined Decompressive Hemicraniectomy and Port-Based Minimally Invasive Parafascicular Surgery for the Treatment of Subcortical Intracerebral Hemorrhage: Case Series, Technical Note, and Review of Literature.
BACKGROUND
Intracerebral 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.


OBJECTIVE
1) 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.


METHODS
The 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).


RESULTS
Three 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.


CONCLUSIONS
Combined DHC-MIPS, with the use of craniometric points, can provide a unique and simple surgical option for the management of subcortical ICH.
['Chakravarthi|Srikant S|SS|', 'Lyons|Leah|L|', 'Orozco|Andres Restrepo|AR|', 'Verhey|Leonard|L|', 'Mazaris|Paul|P|', 'Zacharia|Joseph|J|', 'Singer|Justin A|JA|']
D000328:Adult D020145:Basal Ganglia Hemorrhage D002552:Cerebral Ventricles D056424:Decompressive Craniectomy D004322:Drainage D005260:Female D015600:Glasgow Coma Scale D006801:Humans D019586:Intracranial Hypertension D008297:Male D008875:Middle Aged D019060:Minimally Invasive Surgical Procedures D017397:Prefrontal Cortex D013525:Surgical Instruments
Subcortical Intracerebral hemorrhage (ICH) Decompressive hemicraniectomy (DHC) Minimally invasive parafascicular surgery (MIPS) Craniometric Port