Related Experiment Video
Updated: Jan 7, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Percutaneous Stereotactic Bedside Drainage and Active Fluid Exchange with Alteplase for Rapid Intracerebral
Jesse J McClure1, Eduardo J Medina1, Erica C Webster1
1Department of Neurosurgery, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, West Virginia, USA.
Background And Objectives:
Intracerebral hemorrhage (ICH) is a major cause of morbidity and mortality. Recent treatment options focusing on minimally invasive surgical evacuation have shown benefit in outcomes. Previous trials have also shown some benefit for alteplase infusion in ICH clot in speeding resolution, especially with continuous fluid exchange. Current minimally invasive methods still require high levels of expertise, equipment, and operating room utilization, potentially delaying evacuation and limiting treatment availability. The objective of this study was to investigate the feasibility of a bedside, minimally invasive, active fluid exchange technique for evacuation of ICH.
Methods:
Six patients underwent a bedside, ICH evacuation in the neurocritical care unit supplemented by active fluid exchange with alteplase via intrahematoma dual lumen, irrigating drain catheter. Daily computed tomography scans were reviewed. Volume analysis was performed with automated segmentation using MonoAI and 3D Slicer.
Results:
Four of 6 patients had hematoma evacuation >80% with <15 mL residual volume. One patient died from withdrawal of life-sustaining care. Four/6 patients had evacuation within 24 hours of their last-seen-normal, and 5/6 had evacuation within 6 hours of hospital presentation.
Conclusion:
Bedside stereotactic needle evacuation supplemented with active fluid exchange and alteplase is effective for evacuation of ICH. Future studies will be needed to assess the techniques comparative effectiveness and safety.
