1. Neil A. Martin (Surgical PI) Paul M. Vespa (Medical PI)
Intraoperative CT guided Endoscopic Surgery for Intracerebral Hemorrhage (ICES) Surgical Technique
Neil A. Martin (Surgical PI)
Paul M. Vespa (Medical PI)
UCLA Departments of
Neurosurgery and Neurology

2. UCLA Stroke Center

3. ICES Protocol Initial Screen, CT, MRI, estimation of clot size (cc)
6 hour stability scan
Prepare for OR
Stereotactic placement of burr hole
Stereotactic trajectory for endoscope
Suction of hematoma (start at 50 mm Hg)
Measurement of extracted clot volume (cc)
Hemostasis
Placement of hematoma drain
Repeat imaging
Intraoperative or Postoperative CT
7 day MRI (FLAIR)

6. 35 yo,
Hypertensive,
37 cc hematoma

8. Frontal Supraorbital (eyebrow incision)

9. Suction Point #1 Right Supraorbital Burrhole; Eyebrow incision
Documentation of suction point #1 by screenshot
Suction
Point #1
2/3 of the
distance to the
distal margin of
the hematoma
Right
Supraorbital
Burrhole;
Eyebrow
incision

10. To wall
suction
To suction
catheter in
hemtoma
Trap
Intraoperative method
for measuring amount
of hematoma removed;
and trapping hematoma
with perihematomal
parenchymal fragments
clot
Hematoma: 4 cm diameter
volume = (4x4x4)/2 = 32 cc

11. Suction
Point #2
Endoscope sheath pulled to a point 1/3 of the distance to the distal hematoma margin

15. Pre OP
Post Op Day 1

16. Post OP Day 1

17. Frontal Supraorbital (eyebrow incision)
Post Op Day 7

18. FLAIR MRI,
48 hours postop,
Level of endoscope
pass

19. Post- OP
Day 2

20. Selection of entry point and trajectory

21. Positioning of Mitaka Scope Holder

22. Checking registration of scope sheath

23. Stereotactic image guidance: insertion of Frazee scope sheath into hematoma

24. Suction evacuation of hematoma

25. Measurement of hematoma volume

26. Case 2

28. Lateral Occipital
Approach

32. Next Case 54 years old, male Sudden headache while weight lifting
Rapid coma and right hemiparesis
GCS 5 in the ER

34. Pre a b c d
Post e f g h

35. Outcome: 12 months post-op
Right hemiparesis
Independently ambulatory
Moderate aphasia

36. 83.9 cc
2.8 cc
Baseline
24 Hours
Case 011

37. 68.6 cc
23.9 cc
Baseline
24 Hours
Case 005