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Perihematomal Edema Characteristics After Minimally Invasive Surgery in Intracerebral Hemorrhage
Emma D Frost1, Anika Pruthi2, Daniel Tonetti1,2,3
1Cooper Neurological Institute, Cooper University Hospital, Camden, NJ.
Critical Care Explorations
|December 19, 2025
Summary
Minimally invasive surgery (MIS) for spontaneous intracerebral hemorrhage (sICH) reduces perihematomal edema (PHE) and improves patient outcomes compared to medical or conventional surgical management. These findings suggest PHE
Area of Science:
- Neurosurgery and Neurology
- Cerebrovascular Disease Management
- Medical Technology and Innovation
Background:
- Perihematomal edema (PHE) is a significant factor influencing recovery after spontaneous intracerebral hemorrhage (sICH).
- The comparative effects of minimally invasive surgery (MIS) versus conventional treatments on PHE and functional outcomes in sICH patients are not well-established.
Purpose of the Study:
- To compare the impact of MIS on PHE volumes and functional outcomes against medical management and conventional surgical evacuation in sICH patients.
- To investigate the relationship between PHE dynamics and functional recovery following different sICH treatment modalities.
Main Methods:
- A single-center observational study involving 40 sICH patients categorized into MIS, medical management, and conventional surgical groups.
- Retrospective data collection including hematoma and PHE volume calculations using the ABC/2 method.
- Linear mixed modeling was employed to analyze differences in peak PHE, PHE trajectory, and 90-day functional outcomes (modified Rankin Scale), controlling for ICH score.
Main Results:
- MIS was associated with significantly lower peak PHE burden compared to medical and conventional surgical groups, independent of ICH score (p = 0.001).
- The MIS group demonstrated better 90-day functional outcomes (mean mRS 2.3) compared to medical (mean mRS 3) and conventional surgical groups (mean mRS 4.3).
- While PHE evolved over time in all groups, the temporal trajectory did not differ significantly; however, MIS tended to peak earlier.
Conclusions:
- Minimally invasive surgery for sICH is linked to reduced peak PHE and improved functional outcomes at 90 days, irrespective of initial ICH severity.
- The findings suggest that the temporal profile of edema resolution may be a key mechanism underlying MIS benefits in sICH management.
- Larger prospective studies are warranted to confirm these exploratory findings and optimize sICH treatment strategies.
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