Surgical evacuation of intracerebral hemorrhage using DTT-guided parafascicular Brain Path/Myriad technique

Hemorrhagic stroke is one of the leading causes of morbidity and mortality worldwide. Medical management has been the mainstay of treatment for patients with intracerebral hemorrhage (ICH). However, with the advent of advanced imaging and minimally invasive surgery (MIS) techniques for hematoma evacuation, patients with large ICH could potentially benefit from surgical intervention. Herein, we report a case with a large ICH that was evacuated using a novel DTT-guided parafascicular Brain Path/Myriad technique.

Chart review including clinical data and imaging results were performed as well as literature search.

In this case presented, a 55-year-old woman presented with acute onset of left facial droop, dysarthria, and left hemiparesis. Brain MRI showed a large right basal ganglia hematoma which had displaced the ipsilateral corticospinal tract (CST) medially on DTT imaging. A right anterior parafascicular approach was utilized for an MIS evacuation of the hematoma using Brain Path/Myriad. Post-operative CT head showed excellent evacuation of the hematoma and the patient recovered with stable neurological functions.

Surgical evacuation of ICH using DTT-guided Brain parafascicular Path/Myriad is an excellent method to rapidly decrease the hematoma burden in patients with ICH to protect the CST.