The BrainPath changes how surgeons can move through the natural folds and delicate fibers of the brain. The BrainPath’s obturator is uniquely designed with an atraumatic tip that minimizes tissue damage by displacing tissues of the brain during advancement to the targeted abnormality. The sheath remains in the brain after the obturator is removed to serve as a protective portal for surgeons to easily maintain access to the surgical site.
Additional FDA clearance was granted for BrainPath in July 2015 for design modifications and revised intended use. Revised intended use includes subcortical access to diseases such as primary/secondary brain tumors, vascular abnormalities/malformations, and intraventricular tumors/cysts.
Minimally invasive technologies, such as endoport systems, may offer a better risk to benefit profile for intracerebral hemorrhage ICH evacuation than conventional approaches.
Un thirty-nine consecutive patients the median Glasgow Coma Scale (GCS) score at presentation was 10 (range, 5-15). The thalamus/basal ganglion regions were involved in 46% of the cases. The median hematoma volume and depth were 36 mL (interquartile range [IQR], 27-65 mL) and 1.4 cm (IQR, 0.3-2.9 cm), respectively. The median time from ictus to surgery was 24.5 hours (IQR, 16-66 hours). The degree of hematoma evacuation was ≥90%, 75% to 89%, and 50% to 74% in 72%, 23%, and 5.0% of the patients, respectively. The median GCS score at discharge was 14 (range, 8-15). The improvement in GCS score was statistically significant (P < .001). Modified Rankin Scale data were available for 35 patients. Fifty-two percent of those patients had a modified Rankin Scale score of ≤2. There were no mortalities.
The approach was safely performed in all patients with a relatively high rate of clot evacuation and functional independence 1).
A retrospective review of all patients who underwent EAME of intracerebral hemorrhage ICH from January 2013 to February 2015 using the BrainPath endoport system (NICO, Indianapolis, IN, USA). The baseline and follow-up patient and ICH characteristics were analyzed. Of the 11 patients included for analysis, seven were women (64%), and the median age was 65years (range: 23-84). The ICH was supratentorial in nine patients (82%), and the median ICH score was 2 (range: 1-4). The median preoperative and postoperative ICH volumes were 51cm(3) (range: 8-168) and 10cm(3) (range: 0.4-59), respectively, with a median reduction in ICH volume of 87% (range: 38-99). The median preoperative and postoperative amounts of midline shift were 6.7mm (range: 4.9-14.3) and 3.7mm (range: 2.2-8.9), respectively, with a median reduction in midline shift of 38% (range: 18-61). At the 90day follow-up, four patients (36%) were functionally independent (modified Rankin Scale 0-2). Four patients had ICH-related mortalities (36%). EAME appears to be a safe and effective treatment option for ICH. Further studies are necessary to assess the comparative effectiveness of EAME in relation to medical therapy or other interventional techniques, for the management of ICH patients 2).
Chen et al., report a case of a 34-year-old female with moyamoya disease who presented with intraventricular hemorrhage. CT angiography and digital subtraction angiography revealed an aneurysm located in the wall of the atrium of the right lateral ventricle. Distal endovascular access was not possible, and embolization risked the sacrifice of arteries supplying critical brain parenchyma. Using the BrainPath endoport system, the aneurysm was able to be accessed. Since the fusiform architecture of the aneurysm prevented clip placement, the aneurysm was ligated with electrocautery.
They demonstrate the feasibility of endoport-assisted approach for minimally invasive access and treatment of uncommon, distally located aneurysms 3).
A 77-year-old man presented with a hypertensive ICH of the right putamen, measuring 9 cm in maximal diameter and 168cm(3) in volume.
Ding et al. planned an endoport trajectory through the long axis of the hematoma using frameless neuronavigation. In order to access the optimal cortical entry point at the lateral aspect of the basal frontal lobe, a miniature modified orbitozygomatic skull base craniotomy was performed through an incision along the superior border of the right eyebrow. Using the BrainPath endoport system (NICO, Indianapolis, IN, USA), the putaminal hematoma was successfully evacuated, resulting in an 87% postoperative reduction in ICH volume. Thus, we show that, in appropriately selected cases, endoport-assisted microsurgery is safe and effective for the evacuation of large ICH. Furthermore, minimally invasive anterior skull base approaches can be employed to expand the therapeutic potential of endoport-assisted approaches to include subcortical lesions, such as hematomas of the basal ganglia 4).