Image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage

Spontaneous intracerebral hemorrhage (sICH) has an annual prevalence of approximately 10-30 cases per 10 0000 individuals, constituting a significant source of worldwide morbidity and mortality [1-4]. Within the United States alone, nearly 70 000 cases occur each year, resulting in more than $8 billion in total healthcare costs [5-8]. Risk factors for sICH include hypertension, male gender, African American or Hispanic race, and age; with a particular increase in incidence after 55 years [6,9-11]. As the United States’ population continues to age, the occurrence of sICH is anticipated to double by 2050, representing a significant healthcare issue [10]. Causes of intracerebral hemorrhage include cerebral amyloid angiopathy, aneurysmal rupture, vascular malformations, trauma, tumors, and hemorrhagic stroke. Yet despite best diagnostic efforts, the etiology of spontaneous ICH often remains unknown until lesion tissue can be examined postmortem [12,13]. Hemorrhagic stroke is the most fatal category of infarct, with a 35% mortality rate within 1week of the initial bleeding and 50% mortality during the first month. Additionally, only 10% of patients within the first 4 weeks respond with significant recovery to allow for a quality of life consistent with independent living [14-20]. As such, there has been much debate regarding the ideal treatment strategy to optimize patient outcomes and minimize healthcare costs [21-23].