TY - JOUR
T1 - Intraoperative imaging reveals spot sign with surgical correlate during early endoscopic ICH evacuation
AU - Ali, Muhammad
AU - Scaggiante, Jacopo
AU - Vasan, Vikram
AU - Rossitto, Christina P.
AU - Fifi, Johanna T.
AU - Aviv, Richard
AU - Mocco, J.
AU - Kellner, Christopher P.
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/12
Y1 - 2022/12
N2 - Intracerebral hemorrhage (ICH) is the most devastating form of stroke. Intraoperative imaging and management of intracavity bleeding during early endoscopic ICH evacuation may mitigate rebleeding, hematoma expansion, and neurological worsening. Here we document a case of intraoperative spot sign, detected in the angio suite using cone beam CT with contrast protocol, in a patient with spontaneous supratentorial ICH undergoing evacuation 13 hours after last known well. The spot sign was detected after endoscopic evaluation of the evacuated hematoma cavity demonstrated sufficient hemostasis, but before completion of the case and skin closure, prompting second-pass hematoma evacuation as well as identification and cauterization of the specific correlating bleeding vessel, resulting in near-complete evacuation of the hematoma. Spot sign detection on intraoperative cone beam CT followed by endoscopic ICH evacuation may provide an opportunity to specifically target and treat active bleeding and mitigate impending expansion and neurologic worsening, especially in high-risk patients, including those undergoing early ICH evacuation.
AB - Intracerebral hemorrhage (ICH) is the most devastating form of stroke. Intraoperative imaging and management of intracavity bleeding during early endoscopic ICH evacuation may mitigate rebleeding, hematoma expansion, and neurological worsening. Here we document a case of intraoperative spot sign, detected in the angio suite using cone beam CT with contrast protocol, in a patient with spontaneous supratentorial ICH undergoing evacuation 13 hours after last known well. The spot sign was detected after endoscopic evaluation of the evacuated hematoma cavity demonstrated sufficient hemostasis, but before completion of the case and skin closure, prompting second-pass hematoma evacuation as well as identification and cauterization of the specific correlating bleeding vessel, resulting in near-complete evacuation of the hematoma. Spot sign detection on intraoperative cone beam CT followed by endoscopic ICH evacuation may provide an opportunity to specifically target and treat active bleeding and mitigate impending expansion and neurologic worsening, especially in high-risk patients, including those undergoing early ICH evacuation.
KW - Cone beam CT
KW - Intracerebral hemorrhage
KW - Minimally invasive endoscopic ICH evacuation
KW - Spot sign
UR - http://www.scopus.com/inward/record.url?scp=85140289145&partnerID=8YFLogxK
U2 - 10.1016/j.jstrokecerebrovasdis.2022.106839
DO - 10.1016/j.jstrokecerebrovasdis.2022.106839
M3 - Article
AN - SCOPUS:85140289145
SN - 1052-3057
VL - 31
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 12
M1 - 106839
ER -