Minimally invasive ultrasound-assisted evacuation of Spontaneous Supratentorial Intracerebral hemorrhages: Retrospective observational single-cohort study

OBJECTIVE: To assess safety and efficacy of minimally invasive evacuation of Spontaneous Supratentorial Intracerebral Hemorrhage (SSICH) by means of tailored minicraniotomies and intraoperative ultrasound (iUS) assistance. METHODS: Retrospective analysis of 55 patients who underwent microsurgical evacuation of SSICH using minicraniotomy and iUS assistance, between January 2015 and January 2022. Surgical complications, mortality rate, recurrent bleeding, percentage of hematoma evacuation and reliability of iUS were collected and investigated. The clinical outcomes were measured by the modified Rankin Scale (mRS) at 6 months. Subgroup analysis was performed to assess the differences between the pre-operative GCS (3-9 versus 10-14), the residual hematoma volume (<10ml versus >10ml) and the location (deep versus lobar).RESULTS: 3 patients had an unfavourable outcome owing to surgery. The 6-month overall mortality accounted for 10,9%. Symptomatic recurrent bleeding occurred in 3 cases. 2 patients (3.6%) developed brain swelling treated with decompressive hemicraniectomy. With reference to clinical outcome, 39 patients (70,9%) had a good functional outcome (GFO) and the average 6-month mRS was 2,75 +/- 1,97. Hematoma volume decreased from 54,2 +/- 12,8mL pre-evacuation (range 30-95mL) to 11,1 +/- 12,5mL post-evacuation (range 0-35mL), with an average reduction of 78,15%+/- 16,4% (P < 0.001). iUS was reliable to correctly check hematoma evacuation during the procedure in 46 patients (83.6%). Pre-operative GCS>9 and residual hematoma <10ml were found to be associated with higher probability to have GFO (P < 0.01).CONCLUSIONS: Evacuation of SSICH using minicraniotomy with iUS assistance is a straightforward, affordable, and reproducible technique. Its safety and efficacy profiles appear consistent with other published studies.