SCUBA evacuation within 24 hours of basal ganglia hemorrhage results in promising functional outcomes

Abstract

Background: The recently completed Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH) trial demonstrated a benefit for endoport-mediated evacuation within ≤24 hours for lobar hemorrhages but not for basal ganglia hemorrhages (BGH). We performed an exploratory evaluation of the Stereotactic Cerebral Underwater Blood Aspiration (SCUBA) technique for BGH evacuation.

Methods: We reviewed data from patients presenting to an urban health system with BGH who underwent SCUBA evacuation according to institutional guidelines. Three cohorts were then created: (1) all patients with BGH evacuation using the SCUBA approach; (2) patients with BGH evacuation using SCUBA within ≤24 hours and with ENRICH-defined intraventricular hemorrhage (IVH) selection criteria; and (3) SCUBA evacuation within ≤24 hours, ENRICH-defined IVH, and intracerebral hemorrhage (ICH) volumes of ≥30 mL. Key outcomes included evacuation percentage, residual hematoma volume ≤15 mL, and 6-month modified Rankin Scale (mRS) score of 0-3.

Results: Sixty-eight patients with BGH underwent SCUBA. Median preoperative ICH volume was 35 mL and median postoperative volume was 1.3 mL for a median evacuation percentage of 97%, with 90% achieving ≤15 mL residual volume. For 19 patients in cohort 2 and 12 patients in cohort 3, median evacuation percentages were 98% and 100% of patients had ≤15 mL residual volume in both groups. A good outcome was achieved in 53% and 50% of patients, respectively.

Conclusions: SCUBA evacuation for BGH in patients who otherwise meet ENRICH criteria suggests superior 6-month outcomes compared with ENRICH BGH patients (utility-weighted mRS 0.51 vs 0.34). A randomized clinical trial is warranted to prospectively evaluate SCUBA evacuation within 24 hours in patients with spontaneous BGH.

Keywords: Endoscopy; Hemorrhage; Stroke.