Long-term functional independence after minimally invasive endoscopic intracerebral hemorrhage evacuation

OBJECTIVE Intracerebral hemorrhage (ICH) is a devastating form of stroke with no proven treatment. However, mini-mally invasive endoscopic evacuation is a promising potential therapeutic option for ICH. Herein, the authors examine factors associated with long-term functional independence (modified Rankin Scale [mRS] score <= 2) in patients with spontaneous ICH who underwent minimally invasive endoscopic evacuation. METHODS Patients with spontaneous supratentorial ICH who had presented to a large urban healthcare system from December 2015 to October 2018 were triaged to a central hospital for minimally invasive endoscopic evacuation. Inclu-sion criteria for this study included age >= 18 years, hematoma volume >= 15 ml, National Institutes of Health Stroke Scale (NIHSS) score >= 6, premorbid mRS score <= 3, and time from ictus <= 72 hours. Demographic, clinical, and radiographic factors previously shown to impact functional outcome in ICH were included in a retrospective univariate analysis with patients dichotomized into independent (mRS score <= 2) and dependent (mRS score >= 3) outcome groups, according to 6-month mRS scores. Factors that reached a threshold of p < 0.05 in a univariate analysis were included in a multivari-ate logistic regression. RESULTS A total of 90 patients met the study inclusion criteria. The median preoperative hematoma volume was 41 (IQR 27 & ndash;65) ml and the median postoperative volume was 1.2 (0.3 & ndash;7.5) ml, resulting in a median evacuation percentage of 97% (85%& ndash;99%). The median hospital length of stay was 17 (IQR 9 & ndash;25) days, and 8 (9%) patients died within 30 days of surgery. Twenty-four (27%) patients had attained functional independence by 6 months. Factors independently associ-ated with long-term functional independence included lower NIHSS score at presentation (OR per point 0.78, 95% CI 0.67 & ndash;0.91, p = 0.002), lack of intraventricular hemorrhage (IVH; OR 0.20, 95% CI 0.05 & ndash;0.77, p = 0.02), and shorter time to evacuation (OR per hour 0.95, 95% CI 0.91 & ndash;0.99, p = 0.007). Specifically, patients who had undergone evacuation within 24 hours of ictus demonstrated an mRS score <= 2 rate of 36% and were associated with an increased likelihood of long-term independence (OR 17.7, 95% CI 1.90 & ndash;164, p = 0.01) as compared to those who had undergone evacuation after 48 hours. CONCLUSIONS In a single-center minimally invasive endoscopic ICH evacuation cohort, NIHSS score on presentation, lack of IVH, and shorter time to evacuation were independently associated with functional independence at 6 months. Factors associated with functional independence may help to better predict populations suitable for minimally invasive endoscopic evacuation and guide protocols for future clinical trials.

Automated summary

In this study, the authors investigated factors associated with long-term functional independence in patients with spontaneous intracerebral hemorrhage (ICH) who underwent minimally invasive endoscopic evacuation. They found that NIHSS score on presentation, lack of intraventricular hemorrhage (IVH), and shorter time to evacuation were independently associated with functional independence at 6 months.