Minimally Invasive Navigated Brain Hematoma Evacuation with Ultrasound Monitoring

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DESCRIPTION (provided by applicant): Primary intracerebral hemorrhage is associated with a high mortality rate (44% at 6 months) and severe disability. For those patients who are not good candidates for aggressive medical management, new options for surgical evacuation of the hematoma are required in order to reduce these morbidity and mortality rates. These new techniques must (1) maximize the amount of hematoma that is removed while (2) minimizing the damage to the surrounding normal tissue, (3) be available at the point of care in the intensive care unit (ICU) and (4) be cost effective. The overall goal of this proposal is to develop a minimally invasive tool for evacuation of intracerebral hematomas that is easy to use and suitable for the ICU. The tool will integrate a screw device for aspiration with an ultrasound probe for real-time visualization of the procedure within a sheath that can carry an additional cannula for saline and pharmaceutical delivery. It will be small in order to minimize the trauma to the brain during placement. The tool will house an electromagnetic position sensor so that the surgical intervention can be guided using an electromagnetic navigation system. Navigation will guide probe placement within the targeted volume and provide the image localization for real-time 3D assessment of clot reduction. A locking guide will be used to provide a stable orientation of the brain probe. Gentle suction can be applied to the aspirator to promote evacuation. With this tool, hematoma evacuation will be no more invasive than ventriculostomy catheter placement and can be performed under local anesthetic. To accomplish these goals, robust image segmentation and registration algorithms will be developed that exploit the information content of admission CT scans. With the navigation registered to the admission CT scans, ultrasound images acquired within the hematoma can be reconstructed in real time to determine the volume of the remaining clot. A prototype of this minimally invasive brain probe will be built containing the catheter ultrasound probe, electromagnetic position sensor, aspirating Archimedes' screw, and cannula for delivering saline and pharmaceuticals to the hematoma site. Additional software will be developed to support real-time visualization of the hematoma evacuation based on ultrasound imaging. The complete system will be validated in a series of controlled laboratory experiments. With improved tools such as this, ICH mortality rates may be reduced and the focus shifted to improving neurological outcome. PUBLIC HEALTH RELEVANCE: The proposed brain probe will permit intracranial hematomas (large blood clots in the brain) to be surgically evacuated in a minimally invasive manner in the Intensive Care Unit under a local anesthetic. This surgical treatment will be navigated and utilize ultrasound imaging to indicate the progress of the procedure. Early treatment with this brain probe will lead to lower mortality rates and improved functional outcomes.