Factors affecting the evacuation rate of intracerebral hemorrhage in basal ganglia treated by minimally invasive craniopuncture

• We identify the factors affecting evacuation rate of ICH in minimally invasive craniopuncture.
• The lower the hematoma CT number is, the higher the evacuation rate is.
• Postoperative CSF outflow is associated with high hematoma evacuation rate.
• Higher hematoma evacuation rate is associated with better long-term outcome.

ObjectiveMinimally invasive craniopuncture has been used to treat intracerebral hemorrhage (ICH) for over 20 years in China. However, one-off total evacuation of hematoma cannot be achieved through this procedure because it is not an open surgery. This study is designed to identify factors that can increase the hematoma evacuation rate (ER) of this procedure and to evaluate the influence of ER on long-term outcome.MethodsA total of 309 patients with basal ganglia ICH treated by minimally invasive craniopuncture were analyzed retrospectively. Univariate and multivariate linear regression analyses were used to identify factors correlated with a high ER. The correlation between ER and long-term outcome was also analyzed by logistic regression and the Spearman correlation.ResultsA low hematoma mean CT number (β = −0.773, p < 0.001) and postoperative cerebrospinal fluid (CSF) outflow (β = 0.193, p < 0.001) were found to be independent factors associated with a high ER. In patients with 30–50 ml of hematoma, a high ER was correlated with a high Barthel index improvement (r = 0.611, p < 0.001) and a high modified Rankin scale decline (r = 0.517, p < 0.001). In patients with 50–80 ml of hematoma, a high ER was a protective factor of case fatality (B = −2.297, p = 0.005).ConclusionsThe hematoma mean CT number can predict the efficiency of minimally invasive craniopuncture in patients with ICH. In patients with ventricular involvement, the tip of the puncture needle should be placed close to the tear in the ventricle rather than at the center of the hematoma to facilitate postoperative CSF outflow.