• Adam C Lieber, Ian T McNeill, Jacopo Scaggiante, Dominic A Nistal, Mary Fowkes, Melissa Umphlett, Jonathan Pan, Panos Roussos, Charles V Mobbs, J Mocco, and Christopher P Kellner.
• Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA.
• World Neurosurg. 2018 Dec 24.

BackgroundThe safety and efficacy of brain parenchyma biopsy during minimally invasive (MIS) intracerebral hemorrhage (ICH) clot evacuation has not been previously reported. The objective of this study was to establish the safety and diagnostic efficacy of brain biopsy during MIS ICH clot evacuation and to validate the modified Boston criteria as a predictor of cerebral amyloid angiopathy (CAA) in this cohort.MethodsFrom October 2016 to March 2018, superficial and perihematomal biopsies were collected for 40 patients undergoing MIS ICH clot evacuation and analyzed by the pathology department to assess for various ICH etiologies. Additionally, the admission magnetic resonance imaging or computed tomography scan of each patient was analyzed and evaluated for the likelihood of a CAA etiology based on the modified Boston criteria. Student t test was used to analyze intergroup differences in continuous variables, and a 2-tailed Fisher exact test was used to determine intergroup differences of categorical variables, with significance set at P < 0.05.ResultsTwo of the 40 patients (5%) experienced postoperative rebleed. Four of the 40 patients (10%) had evidence of CAA on biopsy. Patients with CAA on biopsy were older (P = 0.005) and had a higher prevalence of parietal lobe (P = 0.02) and occipital lobe (P = 0.001) hemorrhage. The modified Boston criteria had a sensitivity of 100% (95% confidence interval [CI], 39.6%-100%) and a specificity of 72.2% (95% CI, 54.6%-84.2%) for predicting CAA on biopsy.ConclusionsBrain biopsy in MIS ICH clot evacuation is safe and allows for the diagnosis of various ICH etiologies.Copyright © 2018 Elsevier Inc. All rights reserved.

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