Deep Intracerebral Hemorrhage Evacuation with Vycor Tubular Retractor: A Multicenter Case Series

Area of Science:

• Neurosurgery
• Minimally Invasive Surgery
• Cerebrovascular Surgery

Background:

• Intracranial hemorrhage (ICH) poses significant morbidity and mortality.
• Surgical evacuation of deep ICH remains challenging with limited evidence.
• Minimally invasive techniques are being explored to improve outcomes.

Purpose of the Study:

• To evaluate the feasibility and radiographic outcomes of Vycor tubular retractor-assisted minimally invasive para-fascicular technique for deep ICH evacuation.
• To share institutional experience with this technique.

Main Methods:

• A retrospective review of 10 patients who underwent Vycor tubular retractor-assisted ICH evacuation between 2022 and 2024.
• Collected data included patient demographics, Glasgow Coma Scale (GCS), NIH Stroke Scale (NIHSS), ICH volumes, and Modified Rankin Scale (mRS) scores.
• Analyzed pre- and post-evacuation ICH volumes, time to surgery, surgery duration, and length of stay (LOS).

Main Results:

• Mean preoperative ICH volume was 42.6 mL, reduced to 11.1 mL postoperatively (83% reduction).
• Average GCS was 9.1, NIHSS was 16.8. Average LOS was 17.3 days.
• No technique-related complications, but one patient had rebleeding. Mean discharge mRS was 4.9, increasing to 5.5 at 90 days.

Conclusions:

• Vycor tubular retractors show feasibility for deep ICH evacuation with excellent radiographic results in a small cohort.
• Clinical outcomes in this series were poor, indicating deep ICH surgical evacuation remains an open question.
• Further research is needed to establish the role of surgical evacuation for deep ICH.