Introduction: Multiple clinical trials have failed to show that surgical intervention leads to better outcomes than medical management for patients with intracerebral hemorrhage (ICH). Newer and less invasive surgical techniques have been reported to be safe and technically effective for evacuation of ICH. The purpose of this study is to evaluate clinical outcomes following ICH evacuation using the BrainPath system (NICO, Indianapolis, IN), a tool that allows minimally invasive access to the subcortical space.
Methods: IRB-approved prospective data were collected on patients who underwent ICH evacuation using BrainPath at the Cleveland Clinic from August 2013 to April 2016. Glasgow Coma Score (GCS) was collected upon admission and discharge. NIH stroke score (NIHSS) and modified Rankin score (mRS) were collected upon admission and discharge, and at the 3- and 6-month months follow-up visits.
Results: Thirty-five patients underwent BrainPath-assisted ICH evacuation, with a mean age of 57 ± 16 years and average ICH volume of 50.4 ± 23.5mL. Complications included two patients requiring re-operation due to hematoma re-accumulation (6%), both of whom had serum creatinine greater than 1.5, and one case of wound infection (3%). Eight (23%) patients died during the follow-up period, of which four (11%) died within 30 days of hemorrhage. GCS was 10.1 ± 3.7 on admission and improved to 11.9 ± 2.9 at discharge. NIHSS of surviving patients at pre-operation, discharge, 3-month follow-up, and 6-month follow-up were 18.6 ± 7.7 (n=35), 19.0 ± 8.7 (n=26), 7.8 ± 5.9 (n=19), and 3.7 ± 3.8 (n=12), respectively. mRS at pre-hemorrhage baseline, 3-month follow-up, and 6-month follow-up was 0.7 ± 1.2 (n=35), 4.3 ± 1.5 (n=30), and 3.9 ± 1.9 (n=26), respectively.
Conclusions: Evacuation of ICH using BrainPath is associated with acceptable rates of surgical morbidity. The 30-day mortality rate was better than expected based on admission ICH scores. Patients showed improvement in GCS between admission and discharge, and they showed improvement in NIHSS and mRS at three and six months postoperatively. A comparative study is needed to investigate whether surgical evacuation using this technique results in improved clinical outcomes compared to medical management.