Endoport-assisted surgery for the management of spontaneous intracerebral hemorrhage

The aim of this retrospective study is to report our initial experience with endoport-assisted microsurgical evacuation (EAME) of intracerebral hemorrhages (ICH). Neurosurgical intervention has not been shown to significantly improve patient outcomes after spontaneous ICH. Minimally invasive technologies, such as endoport systems, may offer a better risk to benefit profile for ICH evacuation than conventional approaches. We performed a retrospective review of all patients who underwent EAME of ICH from January 2013 to February 2015 using the BrainPath endoport system (NICO, Indianapolis, IN, USA). The baseline and follow-up patient and ICH characteristics were analyzed. Of the 11 patients included for analysis, seven were women (64%), and the median age was 65 years (range: 23-84). The ICH was supratentorial in nine patients (82%), and the median ICH score was 2 (range: 1-4). The median preoperative and postoperative ICH volumes were 51 cm³ (range: 8-168) and 10 cm³ (range: 0.4-59), respectively, with a median reduction in ICH volume of 87% (range: 38-99). The median preoperative and postoperative amounts of midline shift were 6.7 mm (range: 4.9-14.3) and 3.7 mm (range: 2.2-8.9), respectively, with a median reduction in midline shift of 38% (range: 18-61). At the 90 day follow-up, four patients (36%) were functionally independent (modified Rankin Scale 0-2). Four patients had ICH-related mortalities (36%). EAME appears to be a safe and effective treatment option for ICH. Further studies are necessary to assess the comparative effectiveness of EAME in relation to medical therapy or other interventional techniques, for the management of ICH patients.