1044. Clinical and radiographic outcomes following intracerebral hematoma evacuation via BrainPath-assisted minimally invasive craniotomy

Authors: Ivy Song; Martin Rutkowski, MD; William Mack, MD; Gabriel Zada, MD (Pasadena, CA)

INTRODUCTION: Spontaneous intracerebral hemorrhage (ICH) comprises 10-15% of strokes with a high mortality rate (40%) and low rates of functional independence within 6 months (25%). Minimally invasive parafascicular surgery (MIPS) has emerged in recent years as a potentially safer option for ICH management.
METHODS: We retrospectively identified 25 patients who underwent channel-based ICH evacuation (BrainPath, NICO Corporation) and collected data on patient demographics, clinical presentation, neuro-imaging characteristics, follow-up MRS, GCS, and disposition.
RESULTS: A total of 25 patients with median age 52 years were included, comprised of 16 male (64%) and 9 female (36%) patients. There were 4 frontal, 1 occipital, and 20 basal ganglia hemorrhages; 15 (60%) showed intraventricular extension.  Seventeen (68%) ICHs were left sided. The mean volume was 46 cm3 (range 13.1-101.2 cm3), while the mean clot reduction was 92%.  Mean follow-up time was 5 months. There were 7 total deaths. Left sided ICH was associated with worsened postoperative GCS score (p = 0.014, Chi-square), as was the presence of IVH (p = 0.038, Chi-square); 6 of 7 (86%) patient deaths involved left sided hemorrhages.  Larger hemorrhages were more often associated with mortality (66 cm3 versus 38 cm3) p < 0.005, T-test). There was a trend toward increased clot removal and increased survival (p = 0.092, T-test). The median follow-up MRS was 3.5, a 13% improvement when compared to preoperative median MRS of 4. The median follow-up GCS was 15, a 33% improvement when compared to preoperative median GCS of 10. As expected, patients with higher postoperative MRS scores and lower postoperative GCS were more likely to expire.
CONCLUSIONS: MIPS ICH evacuation offers an effective means of substantial clot removal, which may be associated with improved postoperative outcomes. Trends toward improved postoperative GCS and MRS scores suggest that judicious use of MIPS may benefit well-selected patients.