Intraoperative imaging reveals spot sign with surgical correlate during early endoscopic ICH evacuation |
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| Institution: | 1. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA;2. Department of Radiology, University of Ottawa, Ottawa, Canada;3. HospitalDepartment of Medical Imaging, The Ottawa Hospital, Ottawa, Canada;1. Department of Neurology, Massachusetts General Hospital, Boston, MA, USA;2. Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA;3. Department of Radiology, Massachusetts General Hospital, Boston, MA, USA;1. Department of Neurosurgery, Nakamura Memorial South Hospital, Hokkaido, Japan;2. Department of Neurosurgery, Nakamura Memorial Hospital, Hokkaido, Japan;1. Warren Alpert Medical School of Brown University, Providence, RI, USA;2. Division of Neurology, Mount Auburn Hospital, Cambridge, MA, USA;3. Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA;4. Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA;5. Section of Medical Education, Warren Alpert Medical School of Brown University, Providence, RI, USA;1. Comprehensive Stroke Care Program, Department of Neurology, SreeChitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India;2. Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India;3. Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India |
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| Abstract: | 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. |
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