Effect of mild hypothermia on expression of inflammatory factors in surrounding tissue after minimally invasive hematoma evacuation in the treatment of hypertensive intracerebral hemorrhage

BackgroundWe conducted a case-control study to assess the relative safety and efficacy of minimally invasive endoscopic surgery (MIS) for clot evacuation in patients with basal-ganglia intracerebral hemorrhage (ICH).MethodsWe evaluated consecutive patients with acute basal-ganglia ICH at a single center over a 42-month period. Patients received either best medical management according to established guidelines (controls) or MIS (cases). The following outcomes were compared before and after propensity-score matching (PSM): in-hospital mortality; discharge National Institutes of Health Stroke Scale score; discharge disposition; and modified Rankin Scale scores at discharge and at 3 months.ResultsAmong 224 ICH patients, 19 (8.5%) underwent MIS (mean age, 50.9±10.9; 26.3% female, median ICH volume, 40 (IQR, 25–51)). The interventional cohort was younger with higher ICH volume and stroke severity compared with the medically managed cohort. After PSM, 18 MIS patients were matched to 54 medically managed individuals. The two cohorts did not differ in any of the baseline characteristics. The median ICH volume at 24 hours was lower in the intervention group (40 cm3 (IQR, 25–50) vs 15 cm3 (IQR, 5–20); P<0.001). The two cohorts did not differ in any of the pre-specified outcomes measures except for in-hospital mortality, which was lower in the interventional cohort (28% vs 56%; P=0.041).ConclusionsMinimally invasive endoscopic hematoma evacuation was associated with lower rates of in-hospital mortality in patients with spontaneous basal-ganglia ICH. These findings support a randomized controlled trial of MIS versus medical management for ICH.

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P.104 Peri-cavity atrophy after minimally invasive evacuation of intracerebral hemorrhage

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2018.206 ◽

2018 ◽

Vol 45 (s2) ◽

pp. S43-S44

Author(s):

S Ahmed ◽

J Scaggiante ◽

J Mocco ◽

C Kellner

Keyword(s):

Minimally Invasive ◽

Intracerebral Hemorrhage ◽

Surgical Techniques ◽

Ct Scans ◽

Cavity Volume ◽

Cavity Size ◽

Hematoma Evacuation ◽

Endoscopic Evacuation ◽

Invasive Techniques

Background: Intracerebral hemorrhage (ICH) remains a significant cause of morbidity and mortality. While traditional surgical techniques have shown marginal clinical benefit of ICH evacuation, minimally invasive techniques have shown some promise. Endoscopic evacuation of the hemorrhage may reduce the peri-hematoma edema and subsequent atrophy around the hemorrhage cavity. This study aims to quantify the changes in cavity volume following hematoma evacuation. Methods: Patients from the INVEST registry of minimally invasive ICH evacuation were included retrospectively if follow-up computed tomography (CT) scans were available for analysis. Hematoma cavity volumes were calculated from the immediate post-procedural and three-month follow-up CT scans using the Analyze Pro software. Results: Twenty patients had follow-up CT scans at a mean time of 93 days from hematoma evacuation. The average cavity size at follow-up was 11938.12 mm3 (SD: 6996.49). The change in cavity size compared to the prior CT was 6396.74 mm3 (median 2542; range: -1030-27543; SD: 8472.45). This represented mean growth in cavity volume of 54%. Conclusions: This study provides preliminary data describing increase in cavity size after endoscopic minimally invasive evacuation of ICH. Comparison to atrophy in conservatively-managed patients is a further planned avenue of research.

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