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

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.

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.

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.

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.