# The effect of minimally invasive intracerebral haematoma evacuation on early perihaematomal oedema formation

## TL;DR

Early minimally invasive surgery may reduce swelling around brain hemorrhages, potentially improving patient outcomes.

## Contribution

This study evaluates the effect of early minimally invasive surgery on early swelling formation after brain hemorrhage.

## Key findings

- Early MIS reduced absolute PHO growth compared to standard care.
- Oedema extension distance was greater in the MIS group.
- PHO volumes at 24 hours were similar between groups.

## Abstract

In patients with intracerebral haemorrhage (ICH), perihaematomal oedema (PHO) is considered a marker of secondary injury and is associated with worse functional outcomes. Minimally invasive surgery (MIS) has been suggested to reduce PHO when performed within 72 h of symptom onset. However, the effect of early surgery on PHO formation remains unclear. We aimed to determine the effect of MIS within 8 h of ICH onset on PHO formation.

We included patients with spontaneous, supratentorial ICH ≥10 mL undergoing MIS within 8 h from the DIST-pilot study and compared them to patients receiving standard care from a cohort study. ICH and PHO volumes at baseline and 24(±12) h were manually segmented. The primary outcome was absolute PHO (aPHO) volume at 24 h. Secondary outcomes included aPHO growth between baseline, and 24 h and oedema extension distance (OED).

We included 34 patients (median age 61 years, 68% male) undergoing MIS and 16 patients (median age 65 years, 69% male) receiving standard medical care. At baseline, median ICH, aPHO and OED volume were similar between groups. Median aPHO volume at 24 h was similar between groups (median difference −3.0 mL, 95% CI, −19.4 to 9.8, P =.67), while median aPHO growth was smaller in the MIS-group (median difference −6.8 mL, 95% CI, −18.67 to 0.33, P =.002). Median OED was greater in the MIS-group (median difference 0.18 cm, 95% CI, 0.05–0.40, P =.002).

Absolute PHO growth in the first 24 h after ICH was less pronounced after early MIS than after standard care, suggesting that early MIS may ameliorate secondary injury after ICH.

Graphical abstract