Subdural hematomas (SDH) requiring surgery are associated with significant morbidity in elderly patients. We describe a novel technique/incision for minimizing invasiveness and duration, minimizing recurrence by allowing for resection of subdural membranes and coagulation of the middle meningeal artery (MMA), and providing ease of conversion to a larger craniotomy if needed.

This was a retrospective review of patients who underwent the technique between 2020–2024. We examined the incidence of recurrence requiring re-intervention and additionally compared the cost of supplies/implants of the mini-craniotomy against other craniotomies performed for SDH evacuation and MMA embolization.

Fifteen patients (mean age 71.8 years) underwent the novel mini-craniotomy for evacuation of mixed-density chronic SDHs. The mean SDH thickness and midline shift was 18.7 and 6.3 mm respectively. All patients had radiologic evidence of subdural membranes preoperatively. No patients developed symptomatic recurrence requiring surgical evacuation. The mean supply/implant cost of the mini-craniotomy was additionally significantly less than the cost of other craniotomies for SDH evacuation.

The described mini-craniotomy is safe, effective, utilizes a small incision, allows for MMA coagulation, provides access to coagulate and resect subdural membranes, can easily be turned into a larger trauma-sized craniotomy if necessary, and optimizes wound healing.

In addition to the deleterious effects Covid-19 has on the pulmonary and cardiovascular systems, COVID-19 can also result in damage to the nervous system. This review aims to explore current literature on the association between COVID-19 and intracranial hemorrhage (ICH).

We conducted a systematic review of PubMed for literature published on COVID-19 and ICH. Ninety-four of 295 screened papers met inclusion criteria.

The literature addressed incidence and mortality of ICH associated with Covid-19. It also revealed cases of COVID-19 patients with subarachnoid hemorrhage, intraparenchymal hemorrhage, subdural hematomas, and hemorrhage secondary to cerebral venous thrombosis and ischemic stroke. ICH during COVID-19 infections was associated with increased morbidity and mortality. Risk factors for ICH appeared to be therapeutic anticoagulation, ECMO, and mechanical ventilation. Outcomes varied widely, depending on the severity of COVID-19 infection and neurologic injury.

Although treatment for severe Covid-19 infections is often aimed at addressing acute respiratory distress syndrome, vasculopathy, and coagulopathy, neurologic injury can also occur. Evidence-based treatments that improve COVID-19 mortality may also increase risk for developing ICH. Providers should be aware of potential neurologic sequelae of COVID-19, diagnostic methods to rule out other causes of ICH, and treatment regimens.

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.