1116. Impact of reduction of peri-cavitary edema after minimally invasive endoscopic hematoma evacuation on functional outcome

Authors: Rui Song; Maxwell Horowitz, BA; Olivia Allen; Dominic Nistal, BA; Alexander Chartrain; Jacopo Scaggiante; J Mocco, MD; Christopher Kellner, MD (Brooklyn, NY)

Introduction:

Peri-cavitary edema (PCE) is a cytotoxic and vasogenic reaction to acute blood within the brain parenchyma. It has been reported in the literature to correlate with intracerebral hemorrhage (ICH) volume and time course as well as functional outcomes. As we previously reported, reduction of hematoma volume by minimally invasive (MIS) endoscopic evacuation is correlated to a reduction in PHE. Here we explore the relationship between PCE reduction after MIS endoscpic evacuation and patient outcomes.

Methods:

47 consecutive patients presenting with supratentorial ICH underwent MIS endoscopic hematoma evacuation at the Mount Sinai Health System. Pre and post-operative CT images were analyzed by two separate raters using semi-automated threshold-guided software. Demographic and clinical data were queried from an institutional database. Patients were followed for 1 year and functional status was evaluated at the 1, 3, 6, and 12 month timepoints.

Results:

Average age in our cohort was 63; 7 patients had a premorbid mRS >0. Deep hemorrhages accounted for about 75% and 50% of patients had concurrent IVH; 4 patients had a spot sign on CTA. Average admission GCS, ICH score, and NIHSS was 9.5, 2.1, 18.5 respectively.  Average bleed to evacuation time and operative time were 50 hrs and 1.8 hours, respectively. Average hematoma size and evacuation percentage were 46 cc and 90%. Average edema size pre and post-op were 20.3 cc and 18.2 cc. Hospital length of stay and functional outcome  were not significantly correlated to PCE.

Conclusion:

While there is a relationship between PCE and functional outcomes, we found that patient factors were not correlated to outcomes. Analysis of a larger cohort will be needed to solidify the relationship of PCE after hematoma evacuation and patient outcome.