gms | German Medical Science

Objective: Surgical treatment of spontaneous intracerebral haematomas (ICH) located in the basal ganglia or/and thalamus (BG/T) is challenging. Our study aims to analyze the effect of a minimal invasive method, namely the implantation of an Intraclot Drainage through the Ventricles (IDV), on the radiological and clinical course of patients with non-traumatic ICH of above-mentioned location.

Methods: We analyzed 62 patients with spontaneous supratentorial ICH demonstrating an ICH volume > 15 ml treated in our neuroICU between August 2019 and October 2020. 24 ICH were located in BG/T, whereas 28 ICH were depicted in remaining brain parenchyma (15 eloquent; 13 non-eloquent). Minimal invasive ICH evacuation plus rtPA was performed according to MISTIE protocol. ICH volumetry was estimated via Brainlab software smartbrush 2x (Brainlab, Inc.,Chicago, USA). Favorable radiological and clinical outcome were defined as ICH volume reduction of >30% at third postoperative day and GOS at discharge of 4&5, respectively. Statistical analysis was performed using SPSS v. 26 (IBM Corp. Armonk, USA).

Results: Median age of our cohort war 72 years; 31 (50%) patients were male. Median GCS at admission and discharge, were 9 and 12, respectively. Median ICH volume, median Hemphill’s ICH score and median Charlson comorbidity score at admission were 26,1 ml, 3 and 3, respectively. IDV was performed in 14 patients, whereas 9 patients underwent a non CSF-augmented minimal invasive implantation of intraclot drainage (ID); the remaining cohort was treated either surgically (decompressive craniectomy or microscopical ICH evacuation) or conservative. Patients who underwent IDV plus rtPA demonstrated a more favorable radiological outcome compared to patients treated with ID plus rtPA (p=0.021). No differences of clinical outcome at discharge as well as of complications rate were observed between IDV and ID.

Conclusion: IDV plus rtPA was associated with greater ICH volume reduction compared to non CSF-augmented ID plus rtPA. This method may appear as a safe and effective alternative of minimal invasive ICH evacuation located in basal ganglia or/and thalamus.