Abstract TP436: Minimally Invasive Endoscopic Hematoma Evacuation vs. Best Medical Management for Spontaneous Basal Ganglia Intracerebral Hemorrhage

Abstract

Background: We conducted a case-control study to assess the relative safety and efficacy of Apollo assisted 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 Apollo assisted MIS (cases) with best medical management. The following outcomes were compared before and after propensity-score matching (PSM): in-hospital mortality, discharge National Institutes of Health Stroke Scale (NIHSS) score, discharge disposition, 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 as compared to the medically managed cohort. After PSM, 18 patients in the MIS cohort 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 [40cm 3 (IQR:25-50) vs. 15cm 3 (IQR:5-20), p<0.001). The two cohorts did not differ in any of the pre-specified outcomes measures with the exception of in-hospital mortality which was lower in intervention cohort (28% vs. 56%, p=0.041). The three-month mortality rates tended to be lower in the intervention cohort (38% vs. 60%, p=0.107). The intensive care unit length of stay was similar in the two groups [median LOS in days (IQR): intervention: 9 (7-12) vs. control: 9 (6-12), p=0.497]. The distribution of mRS-scores at discharge and at three months did not differ between the intervention and the control cohort (p by Cochran-Mantel-Haenszel test>0.4). Conclusions: Minimally invasive Apollo assisted 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.