New data increasingly support the potential role for minimally invasive surgery (MIS) methods for evacuation of intracerebral hemorrhage (ICH). The authors retrospectively studied patients with ICH, evaluating nonsurgical patients (N=30), patients undergoing MIS evacuation alone(N=20), and those undergoing MIS with up to 7 days of daily intra-clot urokinase (MIS+U; N=60). All groups had similar baseline characteristics. ICH and peri-hematoma edema (PHE) volume were measured on admission and on a delayed CT. The ICH volume significantly decreased in both treatment groups but not in the control group. Furthermore, treatment groups saw slight reduction in PHE while the control group had an increase. 40% of patients in the MIS+U group did have significant (>33%) hematoma expansion at some point during serial scans and treatment compared to MIS alone (10%) and controls (6.7%; p<0.01) even though the endpoint hematoma volume was reduced overall. In-hospital clinical outcomes showed no significant differences but the study lacked long-term clinical outcome evaluation. Nevertheless, it adds support to further investigation of minimally-invasive surgical and pharmacologic methods for evacuation of spontaneous intracerebral hemorrhage.
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