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  • Characteristics and Outcomes of Patients with Intracranial Hemorrhage Treated with Image-Guided BrainPath-Mediated Parafascicular Hematoma Evacuation by Stroke Volume and Glascow Coma Scale Score

    Final Number:

    Anil Kumar Roy MD; Victoria Phillips PhD; Avilasha Jha MD; Faiz U. Ahmad MD MCh; Gustavo Pradilla MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Several patient case series have documented the safety and effectiveness of minimally-invasive clot evaluation, but little is known about which patient subgroups benefit most from the procedure.1,2 The role of medical co-morbidities has also not been investigated. Here we describe the demographic, clinical and functional outcomes of patients grouped by Glascow Coma Scale (GCS) score and stroke volume on admission that underwent minimally invasive intracerebral hemorrhage (ICH) evacuation

    Methods: A single-center retrospective case series of patients with ICH (n=43) undergoing minimally invasive BrainPath evacuation (MIS) from January 2014 – December 2016 at a comprehensive stroke center located within an urban, public, Level 1 trauma center was reviewed. Demographic, clinical, and outcome measures were compared within subgroups to identify significant differences between them. Improvement on GCS and National Institute of Health Stroke Scale (NIHSS) score from admission to discharge and percent clot evacuation were compared. Predictors of improvement on the three measures were identified though logistic regression.

    Results: Patients with lower GCS admission scores (GCSADM) (3-8) were significantly more likely to show improvement/remain stable on GCS score from admission to discharge compared to those with higher GCS scores (9-15), 78% to 56% respectively. Patients with lower volumes < 60 ml were more likely to show improvement/remain stable on the NIHSS scale than those with volumes = 60 ml, 76% to 37.5% respectively. In risk-adjusted models, a higher GCSADM significantly decreased the likelihood of GCS improvement by 48%, while having diabetes reduced the likelihood by 97%. Having a lobar stroke or kidney disease significantly reduced the likelihood of NIHSS improvement.

    Conclusions: Our results here demonstrate that MIS evacuation of ICH can lead to favorable outcomes in a select group of patients after accounting for medical co-morbidities. Further long term data and studies are required for comparisons to best medical management.

    Patient Care: A role for surgery has not been clearly established in patients with supratentorial intracerebral hemorrhages. The current research is critical to establish which patient groups might be most suitable for minimally invasive clot evacuation.

    Learning Objectives: 1) Briefly review current data on minimally invasive evacuation of intracerebral hemorrhages 2) Describe outcomes for patients undergoing minimally invasive clot evacuation by subgroups based on admission characteristics and medical co-morbities

    References: 1.Labib MA, Shah M, Kassam AB, et al. The Safety and Feasibility of Image-Guided BrainPath-Mediated Transsulcul Hematoma Evacuation: A Multicenter Study. Neurosurgery. Jun 17 2016. 2.Bauer AM, Rasmussen PA, Bain MD. Initial Single-Center Technical Experience With the BrainPath System for Acute Intracerebral Hemorrhage Evacuation. Operative Neurosurgery. 2016.

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