Kunal Bhatia1, Madihah Hepburn2, Endrit Ziu3, Farhan Siddiq4, Adnan I Qureshi2,5. 1. Department of Neurology, University of Missouri, 1 Hospital Drive, DC047.00, Columbia, MO, 65212, USA. bhatiak@health.missouri.edu. 2. Department of Neurology, University of Missouri, 1 Hospital Drive, DC047.00, Columbia, MO, 65212, USA. 3. Department of Neurosurgery, University of Missouri, Columbia, MO, USA. 4. Texas Health Resources Harris Methodist Hospital, Fort Worth, TX, USA. 5. Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA.
Abstract
PURPOSE OF REVIEW: The present review aims to discuss the recent advances in surgical management of spontaneous intracerebral hemorrhage (ICH), safety and efficacy of minimally invasive surgical techniques, and the existing evidence supporting their use. RECENT FINDINGS: Newer surgical techniques, collectively referred to as minimally invasive surgery (MIS), have been evaluated and studied in management of ICH. Stereotactic evacuation of intracerebral hemorrhage using aspiration-irrigation technique has showed significant reductions in the hematoma volume with minimal intra-operative bleeding. Catheter-based evacuation in combination with use of recombinant tissue plasminogen activator (rt-PA) produces lysis and drainage of spontaneous ICH and intraventricular hemorrhage (IVH) rapidly with minimal major adverse events. Recent advances in the management of spontaneous ICH highlights potential advantages including safety and efficacy in clot lysis and reduction in hematoma volume especially with image-guided catheter-based drainage and concurrent use of rt-PA. Controlled trials are required to conclusively establish standard surgical techniques and rt-PA dosage, before incorporating minimally invasive surgery plus rt-PA, as a standard of care in patients with spontaneous ICH.
PURPOSE OF REVIEW: The present review aims to discuss the recent advances in surgical management of spontaneous intracerebral hemorrhage (ICH), safety and efficacy of minimally invasive surgical techniques, and the existing evidence supporting their use. RECENT FINDINGS: Newer surgical techniques, collectively referred to as minimally invasive surgery (MIS), have been evaluated and studied in management of ICH. Stereotactic evacuation of intracerebral hemorrhage using aspiration-irrigation technique has showed significant reductions in the hematoma volume with minimal intra-operative bleeding. Catheter-based evacuation in combination with use of recombinant tissue plasminogen activator (rt-PA) produces lysis and drainage of spontaneous ICH and intraventricular hemorrhage (IVH) rapidly with minimal major adverse events. Recent advances in the management of spontaneous ICH highlights potential advantages including safety and efficacy in clot lysis and reduction in hematoma volume especially with image-guided catheter-based drainage and concurrent use of rt-PA. Controlled trials are required to conclusively establish standard surgical techniques and rt-PA dosage, before incorporating minimally invasive surgery plus rt-PA, as a standard of care in patients with spontaneous ICH.
Authors: Daniel F Hanley; Karen Lane; Nichol McBee; Wendy Ziai; Stanley Tuhrim; Kennedy R Lees; Jesse Dawson; Dheeraj Gandhi; Natalie Ullman; W Andrew Mould; Steven W Mayo; A David Mendelow; Barbara Gregson; Kenneth Butcher; Paul Vespa; David W Wright; Carlos S Kase; J Ricardo Carhuapoma; Penelope M Keyl; Marie Diener-West; John Muschelli; Joshua F Betz; Carol B Thompson; Elizabeth A Sugar; Gayane Yenokyan; Scott Janis; Sayona John; Sagi Harnof; George A Lopez; E Francois Aldrich; Mark R Harrigan; Safdar Ansari; Jack Jallo; Jean-Louis Caron; David LeDoux; Opeolu Adeoye; Mario Zuccarello; Harold P Adams; Michael Rosenblum; Richard E Thompson; Issam A Awad Journal: Lancet Date: 2017-01-10 Impact factor: 79.321
Authors: Ryan J Barrett; Rahat Hussain; William M Coplin; Samera Berry; Penelope M Keyl; Daniel F Hanley; Robert R Johnson; J Ricardo Carhuapoma Journal: Neurocrit Care Date: 2005 Impact factor: 3.210
Authors: Lewis B Morgenstern; J Claude Hemphill; Craig Anderson; Kyra Becker; Joseph P Broderick; E Sander Connolly; Steven M Greenberg; James N Huang; R Loch MacDonald; Steven R Messé; Pamela H Mitchell; Magdy Selim; Rafael J Tamargo Journal: Stroke Date: 2010-07-22 Impact factor: 7.914
Authors: J Claude Hemphill; Steven M Greenberg; Craig S Anderson; Kyra Becker; Bernard R Bendok; Mary Cushman; Gordon L Fung; Joshua N Goldstein; R Loch Macdonald; Pamela H Mitchell; Phillip A Scott; Magdy H Selim; Daniel Woo Journal: Stroke Date: 2015-05-28 Impact factor: 7.914
Authors: Paul Vespa; Daniel Hanley; Joshua Betz; Alan Hoffer; Johnathan Engh; Robert Carter; Peter Nakaji; Chris Ogilvy; Jack Jallo; Warren Selman; Amanda Bistran-Hall; Karen Lane; Nichol McBee; Jeffery Saver; Richard E Thompson; Neil Martin Journal: Stroke Date: 2016-10-06 Impact factor: 7.914
Authors: W Andrew Mould; J Ricardo Carhuapoma; John Muschelli; Karen Lane; Timothy C Morgan; Nichol A McBee; Amanda J Bistran-Hall; Natalie L Ullman; Paul Vespa; Neil A Martin; Issam Awad; Mario Zuccarello; Daniel F Hanley Journal: Stroke Date: 2013-02-07 Impact factor: 7.914