Early Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation

Intracerebral hemorrhage (ICH) is the most deadly form of stroke with a 40% mortality rate and bleak functional outcomes.¹ There is currently no effective treatment of the condition, but preliminary trials focusing on endoscopic minimally invasive evacuation have suggested a potential benefit.^2-4 The "SCUBA" technique (Stereotactic Intracerebral Hemorrhage Underwater Blood Aspiration) builds on prior strategies by permitting effective clot removal with visualization and cauterization of active arterial bleeding.^5-7 The patient was a male in his '50s who presented with left-sided numbness after loss of consciousness and was found to have a right basal ganglia 5 mL ICH with a spot sign on computed tomography angiography CTA (Video 1). The hematoma then expanded to 28 mL and his examination worsened significantly for a National Institutes of Health Stroke Scale score of 15, a Glasgow Coma Scale score of 14, and an ICH score of 1. Approximately 8 hours after the patient was last known to be well, he was taken to the angiography suite for a diagnostic cerebral angiogram and right frontal minimally invasive endoscopic ICH evacuation with the Artemis system. The hematoma was evacuated using the stereotactic ICH underwater blood aspiration technique. After significant debulking of the clot, suction strength was decreased to 25% and irrigation was maintained on high. Sites of active bleeding were cauterized with the endoscopic bipolar cautery. The patient improved neurologically and was discharged from the hospital neurologically intact on postbleed day 4 with a National Institutes of Health Stroke Scale score of 0.