Table 1

Comparison of different innovative minimally invasive techniques for ICH

StudyType of studyMethod of ICH evacuationNo of patientsNeurological outcomeICH scorePreoperative volume (cm3)% ICH removal% ICH-related mortalityProcedure-related complicationsLimitations
 Prybylowski et al 41 Retrospective
case series
EAME with BrainPath System1136% functionally independent at 90-day follow-up, 2 mildly functional independent2 (range:1–4)51 (range 9–168)87% (38%–99%)36Haemorrhage: n=1Small sample size, retrospective nature
Bauer et al 42 Prospective, single-centre study (pilot)BrainPath system18GCS increase preoperatively 10–14 pts2.4 (SD 1.0)52.7 mL (SD 22.9)95.7 (SD 5.8)5.60None reportedSmall sample size, single centre
Labib et al 46 Retrospective multicentre studyMi SPACE approach39Increased GCS from 10 to 15 pts2 (range: 0–3)36 (range: 27–65)>90% in 72% of patients, 75%–89% in 23% of patients and 50%–75% in 5% of patients0Rebleed (n=1), middle cerebral artery perforator infarct (n=1)Retrospective nature
 Griessenauer et al 52 Retrospective matched cohortBrainPath system5Preoperatively GCS 10, postoperatively GCS 32 (1–3)42.3 (SD 9.1) 2 (40)None reportedRetrospective nature, small sample size, delayed treatment time
Apollo System
Spiotta et al 50 Multicentre, retrospective case seriesApollo System29Acute neurological deficits (n=12), chronic neurological deficits(n=2)45.4 (SD 30.8)54.1% (SD 39.1)13.80Rebleeding and increased oedema, decompressive craniectomy (n=2)Retrospective, delayed TTT
 Griessenauer et al 52 Retrospective Matched cohortApollo System5Preoperative GCS 9, postoperative GCS 103 (range: 1–4)50.7 (SD 23.9) 40 (2)No postoperative complicationsRetrospective nature, small sample size, delayed TTT
Kellner et al 51 Retrospective case seriesSCUBA with Apollo System47 42.6 (SD 29.7)88.2% (SD 20.8) Bleeding: IO,6.4% (n=3) and PO, 2.1% (n=1).Functional outcome /ICH characteristics not in article
Goyal et al 49 Retrospective case–control studyApollo System18 2.2 (SD 0.9)40 (range: 21–52)60% (median: 24 cm3)28 Retrospective, assessment of imaging ICH volumes not adjudicated. Disparities in withdrawal of care
Catheter-based pharmacological techniques
Hanley et al 57 Multicentre, phase II clinical trialMISTIE II96 (54 MIS +alteplase, 42 SMC)Admission GCS: 3–8 pts (n=17), 9–12 pts (n=12), 13–15 pts (n=17) 48.2 (SD 19.6)57% (SD 25)9.50Symptomatic bleeding (n=5), asymptomatic haemorrhage (n=3)Small trial size and low screening yield. Did not evaluate efficacy
Hanley et al 58 Multicentre,
phase III clinical trial
MISTIE III499 (250 MIS+alteplase, 249 SMC)Admission GCS: 3–8 pts (n=64), 9–12 pts (n=111), 13–15 pts (n=7541.8 (range: 30.8–54.5)69%9Symptomatic bleeding (n=6), bacterial infections (n=2)
30% serious adverse event at 30 days
Open-label design, use of different sizes and surgeons to perform the procedure
  • GCS, Glasgow Coma Scale; ICH, intracerebral haemorrhage; MIC, minimally invasive surgery; SMC, standard medical care.