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

Objectives: To share our experience with Vycor tubular retractor-assisted ICH evacuation, a minimally invasive para-fascicular technique, across two institutions.

Methods: Between 2022 and 2024, 10 patients (7 males, 3 females) ages 26-78 years, underwent ICH evacuation using Vycor tubular retractors (Vycor Medical Inc, Boca Raton, FL) at two institutions. Baseline patient characteristics and treatment variables were collected from electronic medical records (EMR). Glasgow Coma Scale (GCS), NIH Stroke Scale (NIHSS), ICH, and Modified Rankin Scale (mRS) scores were recorded. We analyzed pre- and post-evacuation ICH volumes, time from symptom onset to surgery, surgery duration, and hospital length of stay (LOS).

Results: All patients had a pre-morbid mRS score of 0. The average GCS was 9.1 and NIHSS was 16.8. The mean preoperative ICH volume was 42.6 mL, reduced to 11.1 mL postoperatively. Surgical duration averaged 117.8 min, and the mean time from symptom onset to surgery was 15.1 h. Postoperatively, ICH volume was reduced by 83%. There were no complications related to the technique but one patient had an episode of rebleeding requiring an open evacuation. Patients had an average ICU stay of 13 days and a total LOS of 17.3 days. The average mRS score at discharge was 4.9, increasing to 5.5 at 90 days.

Discussion: Our findings demonstrate feasibility utilizing Vycor tubes for deep ICH evacuation with excellent radiographic results in a small cohort, although clinical outcomes remained poor. With the ENRICH trial primarily driven by results of cortical ICH evacuation, surgical evacuation of deep ICH remains an open question.