1041. Cavity volume after minimally invasive endoscopic evacuation is dependent on hematoma size but not time to evacuation
Authors: Rui Song; Maxwell Horowitz, BA; Olivia Allen; Alexander Chartrain, MD; Jacopo Scaggiante, MD; J Mocco, MD; Christopher Kellner, MD (Brooklyn, NY)
Minimally invasive endoscopic intracerebral hemorrhage (ICH) evacuation is under investigation in a multicenter randomized clinical trial to evaluate its feasibility, safety, and impact on functional outcomes. Unlike stereotactic thrombolysis, active evacuation often leaves a cavity in place of the hematoma. Here we investigate the significance of the cavity size in patients undergoing this procedure.
47 consecutive patients presenting with supratentorial ICH underwent MIS endoscopic hematoma evacuation at the Mount Sinai Health System. Cavity volume were analyzed by two separate raters using semi-automated threshold-guided software. Demographic and clinical data were queried from an institutional database.
Average age in our cohort was 63.5; eight patients had a premorbid mRS >0. Bleeds in the deep brain structures comprised 70% of the total cohort and IVH occurred concurrently in 51% of hemorrhages. Admission GCS, ICH score, and NIHSS averaged 9.5, 2.1, and 18.2. Average hematoma volume was 44 cc, with percent evacuation reaching 90% on average. Average cavity volume after evacuation was 11.3 cc; cavity size was significantly correlated with pre and post-op hematoma volume (p = 0.03, 0.04 respectively) but not time to evacuation or operative time. Cavity volume was not significantly correlated with hospital length of stay or patient outcomes.
While preliminary analyses of a small cohort showed no correlation between cavity volume and outcome, a larger cohort will be needed to fully assess the relationship and the relationship of cavity volume to post-stroke cerebral atrophy. Interestingly, time to evacuation and operative time did not significantly affect cavity size, suggesting that the brain parenchyma retains elasticity even after delayed evacuation.