Intraoperative imaging reveals spot sign with surgical correlate during early endoscopic ICH evacuation

Muhammad Ali, Jacopo Scaggiante, Vikram Vasan, Christina P. Rossitto, Johanna T. Fifi, Richard Aviv, J. Mocco, Christopher P. Kellner

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Article number106839
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number12
StatePublished - Dec 2022


  • Cone beam CT
  • Intracerebral hemorrhage
  • Minimally invasive endoscopic ICH evacuation
  • Spot sign


Dive into the research topics of 'Intraoperative imaging reveals spot sign with surgical correlate during early endoscopic ICH evacuation'. Together they form a unique fingerprint.

Cite this