Abstract 3022: Image-Guided Endoscopic Evacuation of Spontaneous Intracerebral Hemorrhage

Introduction: Spontaneous intracerebral hemorrhage (ICH) is associated with a high morbidity and mortality rate despite current medical management. The benefits of open surgical evacuation for ICH remain controversial. Here we present initial results of the effectiveness of stereotactic image-guided endoscopic evacuation of ICH. Methods: Over 9-years, 41 patients with ICH (age 65+−14 years, 66% male, average admission GCS 10 & ICH Score 2, 46% with concurrent intraventricular hemorrhage) were treated. The current technique, which evolved from using direct endoscopic visualization, uses frameless stereotactic guidance alone to aspirate at two specified locations within the hematoma. An endoscope sheath is introduced through a bur hole into the hematoma along its long axis. Suction is applied to the sheath, without endoscopic viewing, at two locations, 1/3 and 2/3 of the way through the long-axis of the ICH. Endoscopic visualization of the cavity is then performed to ensure hemostasis. ICH volume was calculated using pre- and postoperative CT measurements ((length x width x height)/2). Results: Pre- and postoperative ICH volumes averaged 56.5 and 15.9cc, respectively, a reduction of 67.6+−41.9% (p<0.0001) with greater than 50% reduction in 78% of patients. Within 30 days, two patients (5%) developed rebleeding, one with acutely increased hematoma volume on postop CT. Average preop modified Rankin Score (mRS) decreased from 4.4 to 4.1 at follow-up (p=0.17). Seven-day and 30-day mortality occurred in 5 (12%) and 1 (2.4%) patients, respectively. This 30-day mortality compares favorably with the predicted rate of 26% based on average ICH score of 2 for the series. There were 2 surgical complications including ipsilateral ischemic stroke and subdural hematoma. Comparing the current aspiration technique to the previous technique, there were trends towards greater average reduction in hematoma volume (81.7% versus 58.5%, respectively, p=0.08) and greater improvement in clinical outcome (average mRS improvement 0.75 points versus 0 points, respectively, p=0.08). Conclusions: Image-guided endoscopic evacuation is a minimally-invasive approach to reduce ICH volume. Greater than 50% reduction in hematoma volume was achieved in the large majority of patients. Further study is required to evaluate the impact of endoscopic ICH evacuation on clinical outcomes compared to other treatments.

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Machine Learning-Based Approaches for Prediction of Patients’ Functional Outcome and Mortality after Spontaneous Intracerebral Hemorrhage

Journal of Personalized Medicine ◽

10.3390/jpm12010112 ◽

2022 ◽

Vol 12 (1) ◽

pp. 112

Author(s):

Rui Guo ◽

Renjie Zhang ◽

Ran Liu ◽

Yi Liu ◽

Hao Li ◽

...

Keyword(s):

Machine Learning ◽

Logistic Regression ◽

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Laboratory Data ◽

Predictive Performance ◽

High Morbidity ◽

Spontaneous Intracerebral Hemorrhage ◽

Receiver Operating Characteristic Curves ◽

Ich Score

Spontaneous intracerebral hemorrhage (SICH) has been common in China with high morbidity and mortality rates. This study aims to develop a machine learning (ML)-based predictive model for the 90-day evaluation after SICH. We retrospectively reviewed 751 patients with SICH diagnosis and analyzed clinical, radiographic, and laboratory data. A modified Rankin scale (mRS) of 0–2 was defined as a favorable functional outcome, while an mRS of 3–6 was defined as an unfavorable functional outcome. We evaluated 90-day functional outcome and mortality to develop six ML-based predictive models and compared their efficacy with a traditional risk stratification scale, the intracerebral hemorrhage (ICH) score. The predictive performance was evaluated by the areas under the receiver operating characteristic curves (AUC). A total of 553 patients (73.6%) reached the functional outcome at the 3rd month, with the 90-day mortality rate of 10.2%. Logistic regression (LR) and logistic regression CV (LRCV) showed the best predictive performance for functional outcome (AUC = 0.890 and 0.887, respectively), and category boosting presented the best predictive performance for the mortality (AUC = 0.841). Therefore, ML might be of potential assistance in the prediction of the prognosis of SICH.

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Image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage

Surgical Neurology ◽

10.1016/j.surneu.2007.12.016 ◽

2008 ◽

Vol 69 (5) ◽

pp. 441-446 ◽

Cited By ~ 65

Author(s):

Chad M. Miller ◽

Paul Vespa ◽

Jeffrey L. Saver ◽

Chelsea S. Kidwell ◽

Stanley T. Carmichael ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Spontaneous Intracerebral Hemorrhage ◽

Image Guided ◽

Endoscopic Evacuation

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Frontal bur hole through an eyebrow incision for image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage

Journal of Neurosurgery ◽

10.3171/2012.7.jns111567 ◽

2012 ◽

Vol 117 (4) ◽

pp. 767-773 ◽

Cited By ~ 23

Author(s):

Justin A. Dye ◽

Joshua R. Dusick ◽

Darrin J. Lee ◽

Nestor R. Gonzalez ◽

Neil A. Martin

Keyword(s):

Glasgow Coma Scale ◽

Minimally Invasive ◽

Intracerebral Hemorrhage ◽

Invasive Technique ◽

Spontaneous Intracerebral Hemorrhage ◽

Midline Shift ◽

Hematoma Volume ◽

Coma Scale ◽

Endoscopic Evacuation ◽

The Mean

Object Surgical evacuation of spontaneous intracerebral hemorrhage (sICH) remains a subject of controversy. Minimally invasive techniques for hematoma evacuation have shown a trend toward improved outcomes. The aim of the present study is to describe a minimally invasive alternative for the evacuation of sICH and evaluate its feasibility. Methods The authors reviewed records of all patients who underwent endoscopic evacuation of an sICH at the UCLA Medical Center between March 2002 and March 2011. All patients in whom the described technique was used for evacuation of an sICH were included in this series. In this approach an incision is made at the superior margin of the eyebrow, and a bur hole is made in the supraorbital bone lateral to the frontal sinus. Using stereotactic guidance, the surgeon advanced the endoscopic sheath along the long axis of the hematoma and fixed it in place at two specific depths where suction was then applied until 75%–85% of the preoperatively determined hematoma volume was removed. An endoscope's camera, then introduced through the sheath, was used to assist in hemostasis. Preoperative and postoperative hematoma volumes and reduction in midline shift were calculated and recorded. Admission Glasgow Coma Scale and modified Rankin Scale (mRS) scores were compared with postoperative scores. Results Six patients underwent evacuation of an sICH using the eyebrow/bur hole technique. The mean preoperative hematoma volume was 68.9 ml (range 30.2–153.9 ml), whereas the mean postoperative residual hematoma volume was 11.9 ml (range 5.1–24.1 ml) (p = 0.02). The mean percentage of hematoma evacuated was 79.2% (range 49%–92.7%). The mean reduction in midline shift was 57.8% (p < 0.01). The Glasgow Coma Scale score improved in each patient between admission and discharge examination. In 5 of the 6 patients the mRS score improved from admission exam to last follow-up. None of the patients experienced rebleeding. Conclusions This minimally invasive technique is a feasible alternative to other means of evacuating sICHs. It is intended for anterior basal ganglia hematomas, which usually have an elongated, ovoid shape. The approach allows for an optimal trajectory to the long axis of the hematoma, making it possible to evacuate the vast majority of the clot with only one pass of the endoscopic sheath, theoretically minimizing the amount of damage to normal brain.

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Location-specific differences in hematoma volume predict outcomes in patients with spontaneous intracerebral hemorrhage

International Journal of Stroke ◽

10.1177/1747493019830589 ◽

2019 ◽

Vol 15 (1) ◽

pp. 90-102 ◽

Cited By ~ 2

Author(s):

Natasha Ironside ◽

Ching-Jen Chen ◽

Victoria Dreyer ◽

Brandon Christophe ◽

Thomas J Buell ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Dependence ◽

Characteristic Curve ◽

Receiver Operator Characteristic Curve ◽

Independent Effect ◽

Study Cohort ◽

Spontaneous Intracerebral Hemorrhage ◽

Hematoma Volume ◽

Multivariable Regression ◽

Ich Score

Background and objective Functional outcome after spontaneous intracerebral hemorrhage (ICH) may vary depending on hematoma volume and location. We assessed the interaction between hematoma volume and location, and modified the original ICH score to include such an interaction. Methods Consecutive ICH patients were enrolled in the Intracerebral Hemorrhage Outcomes Project from 2009 to 2017. Inclusion criteria were age≥18 years, baseline modified Rankin Scale (mRS) score 0–2, neuroimaging, and follow-up. Functional dependence and mortality were defined as 90-day mRS>2 and death, respectively. A location ICH score was developed using multivariable regression and area under the receiver operator characteristic curve (AUROC) analyses. Results The study cohort comprised 311 patients, and the derivation and validation cohorts comprised 209 and 102 patients, respectively. Interactions between hematoma volume and location predicted functional dependence ( p = 0.008) and mortality ( p = 0.025). The location ICH score comprised age≥80 years (1 point), Glasgow Coma Scale score (3–9 = 2 points; 10–13 = 1 point), volume–location (lobar:≥24 mL=2 points, 21–24 mL=1 point; deep:≥8 mL=2 points, 7–8 mL=1 point; brainstem:≥6 mL=2 points, 3–6 mL=1 point; cerebellum:≥24 mL=2 points, 12–24 mL=1 point), and intraventricular hemorrhage (1 point). AUROC of the location ICH score was higher in functional dependence (0.883 vs. 0.770, p = 0.002) but not mortality (0.838 vs. 0.841, p = 0.918) discrimination compared to the original ICH score. Conclusions The interaction between hematoma volume and location exerted an independent effect on outcomes. Excellent discrimination of functional dependence and mortality was observed with incorporation of location-specific volume thresholds into a prediction model. Therefore, the volume–location relationship plays an important role in ICH outcome prediction.

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Intracerebral Hemorrhage-Score Allows a Reliable Prediction of Mortality in Patients with Spontaneous Intracerebral Hemorrhage Managed by Fibrinolytic Therapy

Cerebrovascular Diseases ◽

10.1159/000504246 ◽

2019 ◽

Vol 48 (3-6) ◽

pp. 165-170

Author(s):

Vesna Malinova ◽

Bogdan Iliev ◽

Dorothee Mielke ◽

Veit Rohde

Keyword(s):

Mortality Rate ◽

Intracerebral Hemorrhage ◽

Fibrinolytic Therapy ◽

Clot Lysis ◽

High Morbidity ◽

Hematoma Volume ◽

Chi Square ◽

Prediction Of Mortality ◽

Chi Square Test ◽

Ich Score

Objective: Intracerebral hemorrhage (ICH) is associated with high morbidity and mortality. Prognosis estimation would be helpful for the treatment decision making in ICH patients. The ICH-score was published in 2001 to estimate the 30-day mortality in conservatively treated patients with ICH. We evaluated the reproducibility of the ICH-score in ICH patients undergoing fibrinolytic therapy. Methods: We performed a retrospective analysis of patients with supratentorial ICH managed by fibrinolytic therapy and evaluated the 30-day mortality. The ICH-score was then applied to match the mortality in our patients with the mortality predicted by the ICH-score. The ICH-score is based on parameters available at admission: age, hematoma volume, intraventricular expansion, and clinical status according to the Glasgow Coma Scale. Results: A total of 233 patients were analyzed. The 30-day mortality rate was 30% (70/233). An age of ≥80 years was associated with a significantly higher mortality rate (OR 2.26, chi-square test p = 0.01). A hematoma volume of ≥30 mL led significantly more often to 30-day mortality (OR 3.72, chi-square test p = 0.01). The mortality was significantly higher in the patients with intraventricular hemorrhage (2.97, chi-square test p = 0.003). The ICH-score showed a significant correlation with mortality (chi-square test, p < 0.0001). The following mortality rates were estimated using the ICH-score in our cohort: 1 = 0% (0/13), 2 = 0% (0/51), 3 = 1.3% (1/82), 4 = 43% (13/31), 5 = 100% (56/56). Conclusion: The ICH-score not only allows a reliable estimation of the 30-day mortality in patients with ICH treated conservatively but also treated by clot lysis. Compared to conservative treatment, the fibrinolytic therapy reduced the 30-day mortality in the patients with ICH-scores 1–4. Patients with ICH-score 5 do not have a benefit of fibrinolytic therapy and should no longer be considered to be candidates for fibrinolytic therapy.

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Image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage

Critical Care of the Stroke Patient ◽

10.1017/cbo9780511659096.033 ◽

2014 ◽

pp. 335-347

Author(s):

Justin A. Dye ◽

Daniel T. Nagasawa ◽

Joshua R. Dusick ◽

Winward Choy ◽

Isaac Yang ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Spontaneous Intracerebral Hemorrhage ◽

Image Guided ◽

Endoscopic Evacuation

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Admission Dehydration Status Portends Adverse Short-Term Mortality in Patients with Spontaneous Intracerebral Hemorrhage

Journal of Clinical Medicine ◽

10.3390/jcm10245939 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5939

Author(s):

Felix Lehmann ◽

Lorena M. Schenk ◽

Joshua D. Bernstock ◽

Christian Bode ◽

Valeri Borger ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Hydration Status ◽

Spontaneous Intracerebral Hemorrhage ◽

Midline Shift ◽

Short Term ◽

Cerebral Herniation ◽

Short Term Mortality ◽

Ich Score ◽

Time Of Admission ◽

The Impact

The impact of dehydration at admission of patients with spontaneous intracerebral hemorrhage (ICH) on short-term mortality remains ambiguous due to scarce data. All of the consecutive patients with spontaneous ICH, who were referred to our neurovascular center in 2018/19, were assessed for hydration status on admission. Dehydration was defined by a blood urea-to-creatinine ratio > 80. In a cohort of 249 patients, 76 patients (31%) were dehydrated at the time of admission. The following factors were significantly and independently associated with increased 30-day mortality in multivariate analysis: “signs of cerebral herniation” (p = 0.008), “initial midline shift > 5 mm” (p < 0.001), “ICH score > 3” (p = 0.007), and “admission dehydration status” (p = 0.007). The results of the present study suggest that an admission dehydration status might constitute a significant and independent predictor of short-term mortality in patients with spontaneous ICH.

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Anti-inflammatory genes in PBMCs post-spontaneous intracerebral hemorrhage

Translational Neuroscience ◽

10.1515/tnsci-2021-0003 ◽

2021 ◽

Vol 12 (1) ◽

pp. 58-66

Author(s):

Doan Nguyen ◽

Vi Tran ◽

Alireza Shirazian ◽

Cruz Velasco-Gonzalez ◽

Ifeanyi Iwuchukwu

Keyword(s):

Intracerebral Hemorrhage ◽

Negative Correlation ◽

Mononuclear Cells ◽

Inflammatory Cells ◽

Favorable Outcome ◽

Hospital Length Of Stay ◽

Spontaneous Intracerebral Hemorrhage ◽

Hematoma Volume ◽

Peripheral Blood Mononuclear ◽

Anti Inflammatory

Abstract Background Neuroinflammation is important in the pathophysiology of spontaneous intracerebral hemorrhage (ICH) and peripheral inflammatory cells play a role in the clinical evolution and outcome. Methodology Blood samples from ICH patients (n = 20) were collected at admission for 5 consecutive days for peripheral blood mononuclear cells (PBMCs). Frozen PBMCs were used for real-time PCR using Taqman probes (NFKB1, SOD1, PPARG, IL10, NFE2L2, and REL) and normalized to GAPDH. Data on hospital length of stay and modified Rankin score (MRS) were collected with 90-day MRS ≤ 3 as favorable outcome. Statistical analysis of clinical characteristics to temporal gene expression from early to delayed timepoints was compared for MRS groups (favorable vs unfavorable) and hematoma volume. Principle findings and results IL10, SOD1, and REL expression were significantly higher at delayed timepoints in PBMCs of ICH patients with favorable outcome. PPARG and REL increased between timepoints in patients with favorable outcome. NFKB1 expression was not sustained, but significantly decreased from higher levels at early onset in patients with unfavorable outcome. IL10 expression showed a negative correlation in patients with high hematoma volume (>30 mL). Conclusions and significance Anti-inflammatory, pro-survival regulators were highly expressed at delayed time points in ICH patients with a favorable outcome, and IL10 expression showed a negative correlation to high hematoma volume.

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17p12 Influences Hematoma Volume and Outcome in Spontaneous Intracerebral Hemorrhage

Stroke ◽

10.1161/strokeaha.117.020091 ◽

2018 ◽

Vol 49 (7) ◽

pp. 1618-1625 ◽

Cited By ~ 9

Author(s):

Sandro Marini ◽

William J. Devan ◽

Farid Radmanesh ◽

Laura Miyares ◽

Timothy Poterba ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Spontaneous Intracerebral Hemorrhage ◽

Hematoma Volume

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Abstract TP358: Prehospital Diagnosis of Intracerebral Hemorrhage in a Mobile Stroke Treatment Unit

Stroke ◽

10.1161/str.47.suppl_1.tp358 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Daniel Vela-Duarte ◽

Ramnath Santosh Ramanathan ◽

Atif Zafar ◽

Ather Taqui ◽

Stacey Winners ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Hematoma Expansion ◽

Hospital Treatment ◽

Treatment Team ◽

Hematoma Volume ◽

Treatment Unit ◽

Stroke Treatment ◽

Imaging Characteristics ◽

Mobile Stroke Unit ◽

The Impact

Introduction: The mobile stroke unit (MSTU) is an on-site pre-hospital treatment team that incorporates laboratory and CT scanner and reduces times to treatment for ischemic stroke thrombolysis. The impact of MSTU on treatment and outcomes of intracerebral hemorrhage (ICH) remains unknown. We report our initial experience with ICH encountered on MSTU. Hypothesis: ICH can be quickly identified using MSTU. Hypertension and coagulopathy are common in ICH evaluated on MSTU. Methods: We identified ICH cases from the prospectively collected database encounters. Demographics, clinical features, MSTU imaging and repeat imaging characteristics were reviewed. Initial and follow-up hematoma volume was calculated by the ABC/2 method. Results: Of 295 encounters on MSTU from July 2014 to July 2015, 20 (6.7%) had intracranial hemorrhage, which comprised of 17 intracerebral, 1 subarachnoid and 2 subdural hemorrhages. Median time to CT diagnosis of ICH from emergency medical dispatch was 31 minutes (interquartile range (IQR) 28-36) and that from last known well was 118 minutes (IQR 39-301). Of the 17 ICH patients, 15 (88%) were hypertensive, with a mean systolic blood pressure of 178.1 and diastolic 91.0 mm Hg. Five (29.4%) individuals were found with INR>1.4, 1 of whom received 4-factor prothrombin complex concentrate. Median NIH Stroke Scale was 11 (IQR 7.5-14.5), and median hematoma volume was 10.7 cc (IQR 4.3-30.8). One patient had significant hematoma expansion as defined by >6 cc or 33% relative volume increase. Conclusions: Over 5% of the cases evaluated in the unit presented with ICH, most of whom were hypertensive and had small hematoma volume. MSTU enables early diagnosis of ICH after activation of emergency system, can provide early treatment, and appropriate triage.

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