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Original research
Minimally invasive endoscopic hematoma evacuation vs best medical management for spontaneous basal-ganglia intracerebral hemorrhage
  1. Nitin Goyal1,
  2. Georgios Tsivgoulis1,2,
  3. Konark Malhotra3,
  4. Aristeidis H Katsanos2,
  5. Abhi Pandhi1,
  6. Khalid A Alsherbini1,
  7. Jason J Chang1,4,
  8. Daniel Hoit5,
  9. Andrei V Alexandrov1,
  10. Lucas Elijovich1,5,
  11. David Fiorella6,
  12. Christopher Nickele5,
  13. Adam S Arthur5
  1. 1 Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  2. 2 Department of Neurology, Attikon University General Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
  3. 3 Department of Neurology, West Virginia University Charleston Division, Charleston, West Virginia, USA
  4. 4 Medstar Washington Hospital Center, Washington, District of Columbia, USA
  5. 5 Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  6. 6 Department of Neurosurgery, Stony Brook Medical Center, New York, USA
  1. Correspondence to Dr Adam S Arthur, Semmes-Murphey Clinic, Memphis, TN 38120, USA; aarthur{at}semmes-murphey.com

Abstract

Background We 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).

Methods We 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.

Results Among 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).

Conclusions Minimally 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.

  • endoscopy
  • hemorrhage
  • standards

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Footnotes

  • Contributors All authors of this work met ICMJE criteria for authorship and made substantial contributions to the conception and design, acquisition of data, analysis and interpretation of data, drafting, critical revising, and final approval of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests NG, GT, KM, AHK, AP, KA, JJC, AVA, and CN have no financial relationships to disclose. DH is a consultant for Codman, Neurovascular, Medtronic, MicroVention, Penumbra, Sequent, and Stryker. LE is a consultant for Codman Neurovascular, Medtronic, MicroVention, Penumbra, Sequent, and Stryker. DF, is an unpaid consultant and proctor for ev3/Chestnut Medical. ASA is a consultant for Leica, Medtronic, Microvention, Penumbra, Siemens, and Stryker, receives research support from Microvention, Penumbra, and Siemens, and is a shareholder in Bendit, Cerebrotech, Serenity, and Synchron.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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