Minimally invasive surgery for intracerebral haemorrhage (original) (raw)

Intracerebral hemorrhage: getting ready for effective treatments

Current Opinion in Neurology, 2010

Purpose of review Spontaneous intracerebral hemorrhage (ICH) is the most devastating type of stroke and a leading cause of disability and mortality in the United States and the rest of the world. The purpose of this article is to review recent advances in the management of spontaneous intracerebral hemorrhage. Recent findings Although no interventions have consistently shown an improvement of mortality or functional outcomes after ICH, results from multicenter prospective randomized controlled trials have shown that early hemostasis to prevent hematoma growth, removal of clot by surgical or minimally invasive interventions, clearance of intraventricular hemorrhage, and adequate blood pressure control for the optimization of cerebral perfusion pressure may constitute the most important therapeutic goals to ameliorate secondary neurological damage, decrease mortality, and improve functional outcomes after ICH.

Intracerebral hemorrhage: update and future directions

Arquivos de Neuro-Psiquiatria, 2020

Intracerebral hemorrhage (ICH), defined as bleeding into the brain parenchyma, is a significant public health issue. Although it accounts for only 10 to 15% of strokes, it is associated with the highest morbidity and mortality rates. Despite advances in the field of stroke and neurocritical care, the principles of acute management have fundamentally remained the same over many years. The main treatment strategies include aggressive blood pressure control, early hemostasis, reversal of coagulopathies, clot evacuation through open surgical or minimally invasive surgical techniques, and the management of raised intracranial pressure.

Epidemiology, risk factors, pathophysiology, clinical symptoms, diagnosis and treatment of intracerebral haemorrhage

International journal of novel research and development, 2023

Intracerebral haemorrhage (ICH) is a significant cause of death and disability and current treatment is limited to supportive measures to reduce brain oedema and secondary hematoma expansion. Intracerebral Haemorrhage (ICH) is a subtype stroke with a severe high mortality and disability rate and accounts for about 10-15% of all strokes. The inflammation and coagulation response after ICH would accelerate the formation of brain oedema around hematoma, resulting in a more severe and durable injury. The cause of intracerebral haemorrhages hypertension, smoking, alcoholism, Coagulopathy etc. CT and MRI is the best diagnosis part of ICH. There is no permanent solution to remove ICH but surgery is one of the best solutions to mostly recover of ICH.

Intracerebral Hemorrhage: a common and devastating disease in need of better treatment

World Neurosurgery, 2015

Objective: To review the poor natural history of intracerebral hemorrhage (ICH), current treatment options for ICH, discuss ongoing trials evaluating minimally invasive techniques for clot evacuation, and offer future directions of investigation for management of this devastating disease. Methods: A selective review of recent trials regarding treatment of ICH was performed. Results: Completed trials of medical and surgical management are reviewed. The supportive research for clot evacuation to limit secondary injury is surveyed. We also provide a comprehensive discussion of current data evaluating minimally invasive techniques to achieve clot removal, including MISTIE, CLEAR, and endoscopic evacuation. Conclusion: We encourage the neurosurgical community to pursue improved therapies for ICH. Practice: New minimally invasive treatments for ICH are being developed. Implications: Treatment of ICH is an important area of research and should continue to be aggressively pursued due to the significant societal burden and poor outcomes associated with ICH.

Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

Purpose-The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of spontaneous intracerebral hemorrhage. Methods-A formal literature search of PubMed was performed through the end of August 2013. The writing committee met by teleconference to discuss narrative text and recommendations. Recommendations follow the American Heart Association/American Stroke Association methods of classifying the level of certainty of the treatment effect and the class of evidence. Prerelease review of the draft guideline was performed by 6 expert peer reviewers and by the members of the Stroke Council Scientific Oversight Committee and Stroke Council Leadership Committee. Results-Evidence-based guidelines are presented for the care of patients with acute intracerebral hemorrhage. Topics focused on diagnosis, management of coagulopathy and blood pressure, prevention and control of secondary brain injury and intracranial pressure, the role of surgery, outcome prediction, rehabilitation, secondary prevention, and future considerations. Results of new phase 3 trials were incorporated. Conclusions-Intracerebral hemorrhage remains a serious condition for which early aggressive care is warranted.

European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage

International Journal of Stroke, 2014

Background Intracerebral hemorrhage (ICH) accounted for 9% to 27% of all strokes worldwide in the last decade, with high early case fatality and poor functional outcome. In view of recent randomized controlled trials (RCTs) of the management of ICH, the European Stroke Organisation (ESO) has updated its evidence-based guidelines for the management of ICH. Method A multidisciplinary writing committee of 24 researchers from 11 European countries identified 20 questions relating to ICH management and created recommendations based on the evidence in RCTs using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results We found moderate-to high-quality evidence to support strong recommendations for managing patients with acute ICH on an acute stroke unit, avoiding hemostatic therapy for acute ICH not associated with antithrombotic drug use, avoiding graduated compression stockings, using intermittent pneumatic compression in immobile patients, and using blood pressure lowering for secondary prevention. We found moderate-quality evidence to support weak recommendations for intensive lowering of systolic blood pressure to <140 mmHg within six-hours of ICH onset, early surgery for patients with a Glasgow Coma Scale score 9-12, and avoidance of corticosteroids. Conclusion These guidelines inform the management of ICH based on evidence for the effects of treatments in RCTs. Outcome after ICH remains poor, prioritizing further RCTs of interventions to improve outcome.

Operative management of intracerebral hemorrhage: 3 year experience in multidisciplinary city hospital

Journal of Clinical Medicine of Kazakhstan

Hemorrhagic stroke is a hemorrhage in the brain parenchyma or ventricles resulting from a rupture of an intracerebral vessel or increased permeability of its wall. Intracerebral hemorrhage is a serious medical and social problem associated with high mortality and disability worldwide. Our study aimed to analyze the operative treatment results of patients with hemorrhagic stroke to determine the factors influencing mortality.

Complications of intracerebral haemorrhage

The Lancet Neurology, 2012

Intracerebral haemorrhage (ICH) is the most devastating type of stroke and is a leading cause of disability and mortality. By contrast with advances in ischaemic stroke treatment, few evidence-based targeted treatments exist for ICH. Management of ICH is largely supportive, with strategies aimed at the limitation of further brain injury and the prevention of associated complications, which add further detrimental eff ects to an already lethal disease and jeopardise clinical outcomes. Complications of ICH include haematoma expansion, perihaematomal oedema with increased intracranial pressure, intraventricular extension of haemorrhage with hydrocephalus, seizures, venous thrombotic events, hyperglycaemia, increased blood pressure, fever, and infections. In view of the restricted number of therapeutic options for patients with ICH, improved surveillance is needed for the prevention of these complications, or, when this is not possible, early detection and optimum management, which could be eff ective in the reduction of adverse eff ects early in the course of stroke and in the improvement of prognosis. Further studies are needed to enhance the evidencebased recommendations for the management of this important clinical problem.