Abstract W MP120: Minimally Invasive Subcortical Parafascicular Access for Clot Evacuation. A Paradigm Shift
Bibliographic record
Abstract
Introduction: Spontaneous intracerebral hemorrhage (ICH) is common and causes significant mortality and morbidity. To date, intervention remains uncertain. Neurosurgical therapies for subcortical lesions have been limited by procedure-related injury to the cerebral cortex and adjacent subcortical brain regions. This is particularly relevant for eloquent cortex, therefore surgical therapy is often not performed. Hypothesis: We hypothesized that using an integrated systems approach for Minimally invasive Subcortical Parafascicular Access for Clot Evacuation (MiSPACE) consistently, could result in improved clinical outcomes and protection of eloquent tissue, especially if we focus on minimizing trauma to normal tissue. Methods: We report on this standardized technique incorporating 5 cores of MiSPACE 1) image interpretation and trajectory planning, 2) dynamic navigation, 3) a traumatic access (BrainPath, NICO Corp), 4) optics (Storz), and 5) resection (Myriad, NICO, Corp), wherein all surgeons have been trained through a CME course and have applied the surgical technique and approach in all 25 cases. Pathology, pre- and post-operative clinical and radiographic characteristics and clinical outcome at last follow-up were collected. Results and Conclusions: The cases presented illustrate successful application of the MiSPACE standardized systems approach. Mean pre-operative ICH volume was 47.2 and mean percentage of clot removal was 89%. Most importantly, significant recovery was observed in 89% of patients with no new deficits reported. MRI tractography obtained pre operatively illustrates how collateral tissue preservation can be achieved by trajectory planning. Using the same technique, the same equipment, in a standardized approach in dominant, eloquent cortex and subcortical regions (Table 1) this may lead to improved outcomes. Safety and feasibility studies are required to further assess this promising new therapeutic paradigm.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".