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Hemorrhagic Stroke
Case series
Long-term functional outcome following minimally invasive endoscopic intracerebral hemorrhage evacuation
  1. Christopher P Kellner,
  2. Rui Song,
  3. Jonathan Pan,
  4. Dominic A Nistal,
  5. Jacopo Scaggiante,
  6. Alexander G Chartrain,
  7. Jamie Rumsey,
  8. Danny Hom,
  9. Neha Dangayach,
  10. Rupendra Swarup,
  11. Stanley Tuhrim,
  12. Saadi Ghatan,
  13. Joshua B Bederson,
  14. J Mocco
  1. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  1. Correspondence to Dr Christopher P Kellner, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; christopher.kellner{at}mountsinai.org

Abstract

Background and purpose Preclinical studies suggest that clot removal may mitigate primary and secondary brain injury following intracerebral hemorrhage (ICH). Although the MISTIE trial did not demonstrate an overall outcome benefit, it did demonstrate outcome benefit from effective reduction of clot burden. Minimally invasive endoscopic ICH evacuation may provide an alternative option for clot evacuation.

Methods Patients presenting to a single healthcare system from December 2015 to October 2018 with supratentorial spontaneous ICH were evaluated for minimally invasive endoscopic evacuation. Inclusion and exclusion criteria were prospectively established by a multidisciplinary group in the healthcare system. The prespecified primary analysis was the proportion of patients with modified Rankin Score (mRS) 0–3 at 6 months.

Results One hundred patients met the inclusion and exclusion criteria and underwent minimally invasive endoscopic ICH evacuation. The mean (SD) hematoma size was 49.7 (30.6) mL, the mean (SD) evacuation percentage was 88.2 (20.3)%, and 86% of patients had postoperative residual hematoma ≤15 mL. At 6 months the proportion of patients with an mRS of 0–3 was 46%.

Conclusions This study suggests that minimally invasive endoscopic ICH evacuation may produce favorable long-term functional outcomes. Further evaluation of this technique in a randomized clinical trial is necessary.

  • intracerebral hemorrhage
  • minimally invasive
  • image-guide
  • endoscopic
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/neurintsurg-2019-015528

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    Footnotes

    • Twitter @chriskellnerMD, @JamieRumseyACNP

    • Contributors CPK, ND, RS, ST, SG, JBB, and JM designed the study. CPK, SG, and JM performed the endoscopic ICH evacuation procedure. RS processed the data, performed the analysis, and designed the figures. CPK and RS drafted the manuscript with support from JP, DAN, JS, and AGC. All authors discussed the results, provided critical feedback, and contributed to the final manuscript.

    • Funding This paper was supported in part by a grant from Arminio and Lucyna Fraga.

    • Competing interests JM receives research funding from Penumbra (manufacturer of the Apollo and Artemis devices) for an ongoing clinical trial evaluating endoscopic ICH evacuation using the Apollo or Artemis devices (INVEST, NCT02654015) and has a financial interest in Rebound Therapeutics now owned by Integra. CPK is site PI of the INVEST and MIND studies funded by Penumbra and site PI for the PILLAR study funded by Minnetronix.

    • Patient consent for publication Not required.

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