Long-term functional independence after minimally invasive endoscopic intracerebral hemorrhage evacuation

OBJECTIVE Intracerebral hemorrhage (ICH) is a devastating form of stroke with no proven treatment. However, mini-mally invasive endoscopic evacuation is a promising potential therapeutic option for ICH. Herein, the authors examine factors associated with long-term functional independence (modified Rankin Scale [mRS] score <= 2) in patients with spontaneous ICH who underwent minimally invasive endoscopic evacuation. METHODS Patients with spontaneous supratentorial ICH who had presented to a large urban healthcare system from December 2015 to October 2018 were triaged to a central hospital for minimally invasive endoscopic evacuation. Inclu-sion criteria for this study included 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. Demographic, clinical, and radiographic factors previously shown to impact functional outcome in ICH were included in a retrospective univariate analysis with patients dichotomized into independent (mRS score <= 2) and dependent (mRS score >= 3) outcome groups, according to 6-month mRS scores. Factors that reached a threshold of p < 0.05 in a univariate analysis were included in a multivari-ate logistic regression. RESULTS A total of 90 patients met the study inclusion criteria. The median preoperative hematoma volume was 41 (IQR 27 & ndash;65) ml and the median postoperative volume was 1.2 (0.3 & ndash;7.5) ml, resulting in a median evacuation percentage of 97% (85%& ndash;99%). The median hospital length of stay was 17 (IQR 9 & ndash;25) days, and 8 (9%) patients died within 30 days of surgery. Twenty-four (27%) patients had attained functional independence by 6 months. Factors independently associ-ated with long-term functional independence included lower NIHSS score at presentation (OR per point 0.78, 95% CI 0.67 & ndash;0.91, p = 0.002), lack of intraventricular hemorrhage (IVH; OR 0.20, 95% CI 0.05 & ndash;0.77, p = 0.02), and shorter time to evacuation (OR per hour 0.95, 95% CI 0.91 & ndash;0.99, p = 0.007). Specifically, patients who had undergone evacuation within 24 hours of ictus demonstrated an mRS score <= 2 rate of 36% and were associated with an increased likelihood of long-term independence (OR 17.7, 95% CI 1.90 & ndash;164, p = 0.01) as compared to those who had undergone evacuation after 48 hours. CONCLUSIONS In a single-center minimally invasive endoscopic ICH evacuation cohort, NIHSS score on presentation, lack of IVH, and shorter time to evacuation were independently associated with functional independence at 6 months. Factors associated with functional independence may help to better predict populations suitable for minimally invasive endoscopic evacuation and guide protocols for future clinical trials.