Medical Student Icahn School of Medicine at Mount Sinai New York, New York, United States
Introduction: Cerebral microbleeds (CMBs) are risk factors for intracerebral hemorrhage (ICH) but the impact of CMBs in ICH surgical and functional outcomes remains unclear. Therefore, the goal of this study was to assess the impact of CMB burden in patients undergoing minimally invasive surgery for ICH.
Methods: This study included 187 patients with spontaneous ICH who underwent minimally invasive evacuation surgery between 2015 and 2021. Magnetic resonance scans were reviewed with a neuroradiologist to assess for CMB presence. Relevant data was included in retrospective univariate analyses with patients dichotomized to the presence or lack of CMBs. Univariate models assessing CMB burden were performed for several outcome measures and multivariate regressions controlling for demographic variables were conducted for significant factors.
Results: Of 187 patients, 115 (61.5%) had CMBs. Patients with CMBs had more severe premorbid modified Rankin Scale scores (mRS) (p=0.006). They tended to be older (median age: 65.0 vs. 58.5, p=0.062) with decreased Glasgow Coma Scores (median score: 8.5 vs. 10.0, p=0.064), although these factors did not reach significance. CMBs were not significantly associated with ICH location, whether lobar or deep (p=0.896). Regarding outcomes, CMB presence was associated with prolonged ICU stay (9.9 vs. 5.8 days, p=0.003) and prolonged hospital stay (19.2 vs. 11.8 days, p=0.010) but was not significantly associated with increased surgical rebleeding (p=0.593), longer procedure time (p=0.231), 30-day mortality (p=0.066), or 6-month mRS (p=0.285). In multivariate logistic regressions, CMB burden was significantly associated with an increased likelihood of prolonged ICU stay (OR 4.15[2.04-8.78], p< 0.001) and prolonged hospital stay (OR 2.91[1.44-6.03], p=0.003).
Conclusion : The presence of CMBs was associated with a more severe ICH presentation and longer ICU and hospital stays suggesting patients with CMBs may have higher morbidity in the subacute setting. However, CMB burden did not affect 30-day mortality or 6-month functional outcomes.
