Minimally invasive hematoma evacuation resulted in better functional outcomes after an acute intracerebral hemorrhage

A recent study demonstrated that in cases where surgery was feasible within 24 hours after an acute intracerebral hemorrhage, minimally invasive hematoma evacuation led to better functional outcomes at 180 days in comparison to patients managed with guideline-based medical approaches. Findings of this study were published in the New England Journal of Medicine.

This multicenter, randomized trial involved 175 patients diagnosed with acute intracerebral hemorrhage, specifically lobar hemorrhages. These patients were randomly assigned in a 1:1 ratio to either undergo minimally invasive surgical removal of the hematoma in addition to guideline-based medical management (surgery group) or receive guideline-based medical management alone (control group). The primary efficacy endpoint was the mean score on the utility-weighted modified Rankin scale at 180 days, which ranged from 0 to 1. The trial also incorporated rules for adapting enrollment criteria based on the location of the hemorrhage. The primary safety endpoint was death within 30 days after enrollment.

At 180 days, the mean score on the utility-weighted modified Rankin scale was 0.458 for the surgery group and 0.374 for the control group. Among patients with lobar hemorrhages, the mean between-group difference was 0.127, while for those with anterior basal ganglia hemorrhages, it was -0.013. 9.3% of patients died by 30 days in the surgery cohort and 18.0% in the control cohort.

Thus, it can be concluded that if surgery was possible within 24 hours of an acute intracerebral hemorrhage, minimally invasive hematoma evacuation yielded improved functional outcomes at 180 days compared to patients who underwent guideline-based medical management. The effect of the surgical procedure seemed to be responsible for intervention in cases of lobar hemorrhages.