Introduction: Neuropathologic analyses of parenchymal brain biopsies collected during open and endoscopic intracerebral hemorrhage (ICH) evacuation can provide a more definitive determination of hemorrhage etiology.

Methods: A single surgeon operating at Mount Sinai Hospital and Mount Sinai West collected parenchymal and clot biopsies for forty-three patients undergoing operation for ICH between October 2016 and March 2018 and sent them to the Department of Pathology for analysis. All demographic and pathologic data were collected prospectively.

Results: The average age of patients biopsied was 62.9 years. There were 27 males (63%) and 16 females (37%). Thirty-nine patients (91%) underwent endoscopic clot evacuation, whereas 4 (9%) underwent open surgery. Hemorrhage location was categorized as basal ganglia (n=17, 40%), parietal (n=10, 23%), thalamic (n=7, 16%), frontal (n=6, 14%), temporal (n=4, 9%), occipital (n=3, 7%), and extreme capsule (n=1, 2%), with 8 patients having hemorrhage in more than one location. Pathological biopsy results were as follows: gliosis (n=6, 14%), amyloid (n=5, 12%), ischemic change (n=5, 12%), hypertensive etiology (n=3, 7%), reactive microglia (n=2,5%), arteriosclerosis (n=2, 5%), arteriovenous malformation (n=1, 2%), tumor (n=1, 2%), and no pathological findings (n=22, 51%). Patients positive for amyloid had an average age of 80 years with the following bleed characteristics: parietal only (n=1), occipital only (n=1), frontal+parietal+occipital (n=1), frontal+parietal (n=1), and parietal+occipital (n=1).

Conclusions: Further analysis of CT/MRI imaging is needed to determine the predictive accuracy of various etiologies for ICH.

Patient Care: This research demonstrates the value of performing brain biopsies during minimally invasive intracerebral hemorrhage evacuation, a technique that has not been previously reported.

Learning Objectives: 1. The reader will understand the value of performing a brain biopsy during minimally invasive intracerebral hemorrhage evacuation. 2. The reader will understand the incidence of cerebral amyloid angiopathy in a population of patients presenting with intracerebral hemorrhage eligible for minimally invasive evacuation and biopsy.

References: Kellner CP, Chartrain AG, Nistal DA, et al. J NeuroIntervent Surg Epub ahead of print: 26 March 2018. doi:10.1136/neurintsurg-2017-013719