{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:03:02Z","timestamp":1787025782414,"version":"build-2736575974"},"reference-count":64,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Minimally invasive surgical (MIS) evacuation of basal ganglia hemorrhages has not demonstrated efficacy compared with medical management. Prior study from this group has suggested that MIS evacuation of moderate-sized putaminal intracranial hemorrhages (pICHs) using tubular retractors is associated with favorable functional outcomes. The authors hypothesized that postoperative functional outcomes were improved in patients with moderate-sized pICH compared with those of a matched cohort of medically managed patients.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors performed a single-center retrospective review of patients admitted with non-lesional pICH between 10 and 50 mL from 2013 to 2024. Patients who underwent MIS evacuation were 1:1 matched to medically managed patients based on volume and ICH score. The main outcome was the utility-weighted modified Rankin Scale (uw-mRS) score obtained within 1 year of admission. Regional pICH extension patterns were evaluated by stereotactically localizing pICH volumes in an anatomical coordinate frame.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Sixty-six patients (33 medical and 33 surgical) were included. The uw-mRS score was similar in the medical and surgical cohorts (mean 0.33 vs 0.44, p = 0.174). Mortality was higher in the medically managed group (24% [medical] vs 3% [surgical], p = 0.010). The median ICU length of stay (LOS) was 3 days shorter in the surgical arm (7 vs 4 days, p = 0.045). Anteromedial extension in the region of the anterior limb of the internal capsule and caudate predicted poor outcome (mRS scores 4\u20136) in surgically managed patients (area under the curve [AUC] 0.74, p = 0.006), while posterior and superior extension in the region of the frontal lobe predicted poor outcomes in medically managed patients (AUC 0.74, p = 0.045). The incremental cost-effectiveness ratio was $68,462.55 per quality-adjusted life year for surgical evacuation compared with medical management.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n In this study, MIS evacuation of moderate-sized pICHs was associated with improved mortality rates, shorter ICU LOS, and cost-effectiveness. Putaminal ICH morphology can differentially predict functional outcome based on management strategy.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.3.jns2565","type":"journal-article","created":{"date-parts":[[2025,7,12]],"date-time":"2025-07-12T01:29:48Z","timestamp":1752283788000},"page":"1514-1521","source":"Crossref","is-referenced-by-count":2,"title":["Minimally invasive surgical evacuation confers a mortality benefit in patients with moderate-sized putaminal hemorrhages"],"prefix":"10.3171","volume":"143","author":[{"given":"Ahmed","family":"Kashkoush","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland; and"},{"name":"Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel T.","family":"Lilly","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Winkelman","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Davison","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Achey","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland; and"},{"name":"Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Shazam","family":"Hussain","sequence":"additional","affiliation":[{"name":"Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joao","family":"Gomes","sequence":"additional","affiliation":[{"name":"Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"Rasmussen","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland; and"},{"name":"Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varun R.","family":"Kshettry","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland; and"},{"name":"Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Moore","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland; and"},{"name":"Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Bain","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland; and"},{"name":"Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"9675","key":"b1","series-title":"Lancet","first-page":"1632","article-title":"Intracerebral haemorrhage","volume":"373","author":"Qureshi AI","year":"2009","unstructured":"Qureshi AI, Mendelow AD, Hanley DF. 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Sci Rep. 2018;8(1):4819."},{"issue":"10175","key":"b3","series-title":"Lancet","first-page":"1021","article-title":"Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial","volume":"393","author":"Hanley DF","year":"2019","unstructured":"Hanley DF, Thompson RE, Rosenblum M, Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial. 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Stroke. 2015;46(8):2238\u20132243."},{"issue":"5","key":"b15","series-title":"Oper Neurosurg (Hagerstown)","first-page":"408","article-title":"Prognosticators of functional outcome after supratentorial minimally invasive intracranial hemorrhage evacuation with tubular retractor systems","volume":"25","author":"Kashkoush AI","year":"2023","unstructured":"Kashkoush AI, El-Abtah ME, Achey R, Prognosticators of functional outcome after supratentorial minimally invasive intracranial hemorrhage evacuation with tubular retractor systems. 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