Outcomes in ICH patients not different with minimally invasive surgery vs medical management

For patients with supratentorial intracerebral haemorrhage (ICH), minimally invasive surgery is not superior to medical management alone in terms of improving mortality and disability outcomes, according to data from the open-label MIND clinical trial.

MIND included 236 adult patients (median age 60 years, 36.9 percent female) with moderate- to large-volume supratentorial ICH (20–80 mL), baseline NIHSS score of ≥6, and Glasgow Coma Scale score between 5 and 15. These patients were randomly assigned to undergo minimally invasive surgery within 72 h of symptom onset plus medical management (n=154) or medical management alone (n=82).

The primary outcome was 180-day combined death and disability, assessed using ordinal modified Rankin Scale score (range, 0 [no symptoms] to 6 [death]), while the primary safety outcome was 30-day mortality.

Enrolment was stopped at 236 patients following an independent feasibility analysis prompted by the publication of positive results of a contemporaneous ICH trial. At baseline, 164 patients (69.5 percent) had deep bleeds, and 72 (30.5 percent) had lobar bleeds.

Compared with medical management alone, minimally invasive surgery did not significantly reduce 180-day death and disability (adjusted odds ratio, 1.10, 96 percent confidence interval [CI], 0.66–1.85; p=0.35).

By 30 days, 11 patients in the surgery group and eight in the medical management group had died (7.2 percent vs 9.8 percent; difference, −2.5 percent, 95 percent CI, −11.7 to 4.8).