Abstract Details

Title Comparative Outcomes of Open Craniotomy and Minimally Invasive Surgery for Intracerebral Hemorrhage

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) N3 - Neuroscience in the Clinic: Surgical Treatment of Intracerebral Hemorrhage (4:55 PM-5:10 PM)

Poster/Presentation
Number 002

Background Intracerebral hemorrhage (ICH), whether spontaneous or traumatic, remains a critical concern in neurosurgical care due to its high morbidity and mortality. Surgical intervention, specifically hematoma evacuation, is essential to prevent secondary brain damage. This study compares open craniotomy with minimally invasive surgery (MIS) techniques, including neuroendoscopy and stereotactic aspiration, to determine their effectiveness in improving outcomes.

Objective This study compares the outcomes of traditional open craniotomy and minimally invasive surgery (MIS) techniques in treating supratentorial ICH, focusing on hematoma clearance, postoperative complications, and long-term functional outcomes.

Design/Methods Data were analyzed from the MISICH trial, which included 733 patients. Of these, 121 patients with hypertensive ICH were randomized into two groups: 42 received medical treatment, and 79 underwent surgery (MIS with rt-PA or craniotomy). Of the 493 excluded, 318 (64.5%) did not meet inclusion criteria, and 175 (35.5%) refused consent. Inclusion criteria required patients to have hematoma volumes between 30-80 ml, GCS scores of 5-14, and symptom onset within 24 hours. The primary outcome was functional recovery (mRS 0-2) at 6 months.

Results In the MISICH trial, the MIS group showed greater hematoma volume reduction (19.6 ml) compared to the medical treatment group (40.7 ml). The average hematoma clearance was recorded at 88.3% (SD 20.8) for endoscopy, 60.3% (SD 25.6) for aspiration, and 86.5% (SD 17.9) for craniotomy (P = 0.000). Intraoperative blood loss was lower in endoscopy (88 mL) and aspiration (38 mL) compared to craniotomy (268 mL) (P = 0.000). The incidence of postoperative pneumonia was 31.9% in craniotomy, 22.6% in endoscopy, and 18.3% in aspiration (P = 0.002).

Conclusions MIS techniques, particularly neuroendoscopy and stereotactic aspiration, provide superior outcomes compared to craniotomy for treating ICH. They demonstrate better hematoma drainage, reduced blood loss, and lower postoperative infection rates. These findings suggest MIS techniques should be primary treatment options for ICH.

Authors/Disclosures
Ashley Lopez, DO PRESENTER	Dr. Lopez has a non-compensated relationship as a Editorial Board Member with Neurology Resident & Fellow Section that is relevant to AAN interests or activities.
Muhammad H. Karim	Muhammad H. Karim has nothing to disclose.

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