A National Registry Analysis on Minimally Invasive Surgery for Intracerebral Hemorrhage: Santosh Murthy, MD, MPH

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“In addition to exploring longterm functional outcomes, the important thing to also see would be the time to the surgical intervention, with the assumption that ‘time is brain’ is also applicable to ICH like it is applicable to ischemic stroke. As soon as patients ‘hit the door’ with an ICH, I think it probably would be interesting to see how every minute or every second we lose would harm our patients. So, time to surgery is probably also equally important in these patients.”

In 2 randomized clinical trials (MISTIE III, NCT01827046; and ENRICH, NCT02880878), investigators observed conflicting results in the efficacy of emergent minimally invasive surgery (MIS) for improving outcomes following nontraumatic intracerebral hemorrhage (ICH). In a recent study of patients with ICH presented at the 2024 International Stroke Conference (ISC), February 7-9, in Phoenix, Arizona, findings showed that emergent MIS was associated with lower in-hospital mortality.¹ The researchers noted that longer-term follow up data with ascertainment of functional outcomes will provide more knowledge on the benefit of surgery following ICH.

Led by Santosh Murthy, MD, MPH, investigators conducted a retrospective cohort study of patients with ICH in the Get With The Guidelines-Stroke registry between 2011 and 2021. The study exposure was MIS (n = 703), defined as a composite of stereotactic surgical evacuation (n = 330) and endoscopic surgical evacuation (n = 391), and in-hospital mortality was set as the primary outcome. In-hospital deaths occurred in 63 (13%) patients who underwent MIS and 96 (20%) patients without surgery. In the regression analyses, MIS was associated with lower in-hospital mortality at discharge (aOR, 0.4; CI, 0.3-0.6).

Prior to the meeting, lead author Murthy, an associate professor of neurology at Weill Cornell Medicine, talked about how the findings compare with results from previous trials like MISTIE III and ENRICH. He also spoke about the limitations of the study, particularly in terms of assessing long-term functional outcomes. Additionally, Murthy discussed how the time to surgical intervention could potentially impact the outcomes for patients with intracerebral hemorrhage if investigated further in future research.

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REFERENCES
1. Murthy SB, Zhang C, Garton A, et al. Minimally Invasive Surgery is Associated With Lower Mortality After Spontaneous Intracerebral Hemorrhage in the Get With the Guidelines Registry. Presented at: 2024 International Stroke Conference; February 7-9; Phoenix, AZ. Abstract 46.