569 Functional Recovery from Thalamic Intracerebral Hemorrhage Following Minimally Invasive Evacuation

Abstract

INTRODUCTION: Intracerebral hemorrhage (ICH) carries a high risk of disability and death, with thalamic hemorrhages associated with the worst outcomes. A minimally invasive (MIS) approach is a promising option to reduce time-to-treatment and prevent further injury during ICH evacuation. The functional outcomes of thalamic ICH evacuation should be accounted for when considering patient eligibility for MIS Hemorrhage Evacuation. METHODS: Patients with spontaneous thalamic ICH who presented to a large healthcare system between December 2015 and December 2021 were triaged to a central hospital for MIS endoscopic or surgiscopic evacuation. Criteria for inclusion was 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. RESULTS: MIS evacuation was performed on 29 patients. 19 patients had hemorrhage confined to the thalamus, whereas 10 patients had hemorrhages extending into surrounding parenchymal structures. 25 patients (86%) had intraventricular hemorrhage. The average preoperative volume was 42.5 mL ± 33.7 mL and postoperative volume was 8.6 ± 11.3 mL indicating an evacuation rate of 78.0 ± 25.0%. One month after hemorrhage, two patients (6.9%) had expired. At 6-month, 6 patients (22.2%) had improved to a favorable outcome (mRS ≤ 3) with 2 patients lacking mRs outcome data. CONCLUSIONS: This study suggests that MIS evacuation can be safely performed in patients with thalamic hemorrhage. Moreover, it presents long-term functional outcomes to assist clinicians in determining treatment plans, and dictating randomization schemes or subgroup analyses for future comparison of MIS evacuation to standard hemorrhage evacuation.