Surgeons performed the first reported case of an acute left | Figure 1
Cleveland Clinic
Surgeons performed the first reported case of an acute left intracerebral hemorrhage (ICH) evacuation with a side-cutting aspiration device performed via endoscopic approach proved safe and efficacious.
A 50-year-old woman with no significant past medical history was transferred to our center emergently with a diagnosis of acute left intracerebral hemorrhage (ICH), noted severe right-sided hemiplegia and aphasia and a National Institutes of Health Stroke Scale score of 27.
Head CT showed a 6.3-cm hematoma in the putamen of the left basal ganglia (Figure 1).
We obtained a CT angiogram (CTA) to rule out vascular lesions as part of our standard preoperative workup at Cleveland Clinic. Though spot sign was not present, CTA revealed a slight expansion of the parenchymal hematoma and intraventricular extension. The team also noted blood in the ipsilateral ventricle.
Given the hematoma’s size, expansion and presence with intraventricular hematoma (IVH), we explored surgical evacuation, opting for an endoscopic, transcortical approach with a side-cutting aspiration device.
An immediate postoperative CT demonstrated clear midline recovery with no evidence of mass effect. The patient began physical therapy on postoperative day 2. When she was discharged on postoperative day 10, she was alert, oriented and slowly regaining strength.
At one-month follow up, axial head CT showed complete resolution of brain shift and little evidence of the surgical tract (Figure 2). The patient was ambulatory but experiencing residual expressive aphasia and right-sided weakness. She continues to improve with appropriate therapies.
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