Perihematomal Edema Characteristics After Minimally Invasive Surgery in Intracerebral Hemorrhage.

objectivesPerihematomal edema (PHE) impacts recovery after spontaneous intracerebral hemorrhage (sICH). How minimally invasive surgery (MIS) affects PHE compared with medical management and conventional surgical management (craniotomy or decompressive craniectomy), and whether this relates to functional outcomes remains poorly understood.

designIn this single-center observational study including 40 patients (MIS n = 16, medical management n = 13, conventional surgical evacuation, n = 11), we assessed PHE volumes and functional outcomes after MIS for sICH and compared them with medical management and conventional surgical management. We collected data retrospectively, calculating hematoma and perihematomal volumes using the validated ABC/2 method (A = maximal diameter, B = orthogonal diameter, C = slice count × thickness). We used linear mixed modeling in IBM SPSS (statistical software package) to detect differences in peak PHE, interaction between PHE and days, and differences in functional outcomes across the three treatment groups. ICH score was a covariate in all modeling. The outcomes were peak PHE volume, PHE trajectory comparison across treatment groups, and 90-day functional outcome. Research was institutional review board approved and conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional or regional) and with the Helsinki Declaration of 1975.

settingStudy was conducted in a single tertiary care center with 24-hour neurocritical care and neurosurgical services.

interventionsPatients were grouped based on which intervention they underwent. As study was conducted retrospectively, intervention (medical management, surgical evacuation, MIS) were determined based on clinical appropriateness. MEASUREMENTS AND MAIN

resultsWe collected data retrospectively, calculating hematoma and perihematomal volumes using the validated ABC/2 method. PHE trajectory was compared with 90-day functional outcome and time across all groups. MIS was associated with significantly lower peak PHE burden, compared with medical and conventional surgical treatment groups, after accounting for ICH score (F [2, 118] = 7.26; p = 0.001). PHE evolved over time, across all treatment groups (F [9, 118] = 2.26; p = 0.023). MIS tended to peak earlier, but the shape of the PHE trajectory over time did not differ significantly between groups (F [16, 118] = 1.18; p = 0.295). MIS was associated with better functional outcomes (90-d modified Rankin Scale [mRS]) based on treatment type (p < 0.001) with the MIS group having the lowest average mRS 2.3 ± 1.49, medical management group having an average of 3 ± 2, and the standard evacuation group having average of 4.3 ± 1.4, after accounting for ICH score. Higher baseline ICH score also independently associated with worse outcome (F [1, 143] = 4.37; p = 0.038). While the sample size was small and results are exploratory, together the findings suggest that treatment modality for sICH influences both long-term functional outcomes and PHE burden, independent of baseline ICH severity. These findings suggest the temporal profile of edema resolution, rather than merely its volume, may be a key mechanism underlying MIS benefits in sICH management.

conclusionsIn this observational exploratory study, MIS, compared with both medical therapy and conventional surgery, was associated with reduced peak of PHE and better 90-day functional outcome, independent of baseline sICH severity. The difference in temporal trajectory of edema, while may be clinically meaningful, was not statistically significant between treatment strategies. Larger prospective studies with standardized imaging protocols are needed to validate these observations and explore their implications for optimizing post-ICH care.