Position Statement on Minimally Invasive Surgery (MIS) for Intracerebral Hemorrhage (ICH) Evacuation by Non-Neurosurgeons
Neurosurgical intervention has evolved through technological advancements, minimally invasive techniques, and a focus on improving patient outcomes and safety. Recent print and conference presentations have suggested that non-neurosurgeons are capable of performing minimally invasive surgical evacuation of intracerebral hemorrhage (MIS ICH).1 Proponents contend that nonneurosurgeons can perform MIS ICH with only a short didactic course followed by 5-10 proctored cases. We believe this expansion of scope and insufficient training of non-neurosurgeons to perform neurosurgical procedures would risk jeopardizing patient outcome and safety.
In the US, proficiency in craniotomy for evacuation of ICH requires a nationally accredited seven-year neurosurgery residency training program. Optimal and safe ICH evacuation involves a carefully planned scalp incision, opening the skull (via burr hole, craniotomy, or craniectomy) incision of the dura, and dissection through the brain to locate and evacuate the ICH, followed by meticulous hemostasis and closure. Patient safety has been improved by neurosurgical innovations such as neuro-navigation, superior illumination and magnification, and advanced systems for brain retraction. MIS ICH was developed to combine these advances to perform ICH evacuation with less invasiveness and minimized tissue disruption. However, MIS ICH as a technique does not obviate the required proficiency in safe ICH localization, evacuation, hemostasis, and closure. This technological innovation is intended to provide a proficient neurosurgeon with an additional surgical option for carefully selected patients. MIS ICH is not intended to expand the scope of neurosurgical procedures for indiscriminate use by non-neurosurgeons without the requisite neurosurgical training or certification. MIS ICH is an advancement in neurosurgical technique — not a substitute for neurosurgeons.
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