2025 American Academy of Neurology Abstract Website

Objective:

To understand the trajectory of early perihematomal edema(PHE) and understand its role in recovery after MIS for ICH evacuation.

Background:

PHE plays a significant role in recovery after spontaneous intracerebral hemorrhage (ICH). Its formation is multifactorial, including shifts in hydrostatic pressure, osmotic gradients, tissue ischemia, hemolysis, and cytotoxic edema due to neuronal injury. However, its trajectory and relationship with short-term outcomes following minimally invasive surgery (MIS) for ICH evacuation remain poorly understood.

Design/Methods:

We analyzed 16 consecutive patients presenting with ICH who underwent MIS hematoma evacuation. A prospective registry was created for data collection. Edema extension distance, hematoma and perihematoma volumes were calculated by two independent investigators using the validated volumetric measurement method of ABCD/2, and multivariable linear regression identified key associations.

Results:

Our results show that PHE increased progressively from deep, to cortical, to both deep and cortical bleed locations after controlling for confounders (p=0.047). Additionally, a deeper hemorrhage location (p=0.003), lower admission GCS (p=0.039) and paradoxically, a postoperative decrease in PHE (p=0.037) were associated with worse discharge outcomes, suggesting early PHE might reflect a protective or reparative response.

Conclusions:

In our small cohort, a decrease in PHE immediately after MIS evacuation was associated with worse mRS scores at discharge. These findings challenge the assumption that reducing PHE is uniformly beneficial. Instead, early PHE may signal neuroprotection or active healing, underscoring the need to reconsider therapeutic strategies. Larger studies are warranted to clarify the complex role of PHE in ICH recovery and inform targeted interventions.