Experimental Intracerebral Hemorrhage: Early Removal of a Spontaneous Mass Lesion Improves Late Outcome

Nehls, Daniel G.; Mendelow, David; Graham, David I.; Teasdale, Graham M.

doi:10.1227/00006123-199011000-00002

Cited by 92 publications

(39 citation statements)

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“…The surgical evacuation of ICH is believed to reduce damage to the surrounding brain parenchyma, thereby, improving patient outcomes by relieving local ischemia and removing noxious agents [19][20][21][22]. The additional trauma and physiological burden caused by conventional transcortical approaches may be partially responsible for the failure of surgical trials.…”

Section: Discussionmentioning

confidence: 99%

Endoport-assisted surgery for the management of spontaneous intracerebral hemorrhage

Przybylowski

Ding

Starke

et al. 2015

Journal of Clinical Neuroscience

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Section: Discussionmentioning

confidence: 99%

Endoport-assisted surgery for the management of spontaneous intracerebral hemorrhage

Przybylowski

Ding

Starke

et al. 2015

Journal of Clinical Neuroscience

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“…Consequently, reducing the mass effect and perihematomal edema by surgery can be expected to cause clinical improvement. In addition, Nehls et al [28] showed that the early removal of a microballoon mimicking a spontaneous mass lesion increased the blood flow and reduced ischemic changes, in comparison to permanent balloon inflation. Therefore, the importance of developing an effective treatment is obvious.…”

Section: Discussionmentioning

confidence: 99%

Gross-total hematoma removal of hypertensive basal ganglia hemorrhages: A long-term follow-up

Zuo

Cheng

Gao

et al. 2009

Journal of the Neurological Sciences

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“…This is strong evidence for the presence of a zone of reversible neuronal injury. Experimental studies in animals have suggested that early removal of the mass lesion can reduce the ischaemic damage 21 . SPECT studies in a series of 14 patients in our department showed greater recovery in the 'ischaemic penumbra' in patients undergoing surgery for evacuation of the haematoma compared with those managed conservatively 22 .…”

Section: Zone Of Reversible Injury Surrounding An Ichmentioning

confidence: 99%

Critical Care Management and Monitoring of Intracranial Pressure

Ragland

Lee

2016

J Neurocrit Care

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There is at present no clear indication for surgical removal of intracerebral haemorrhage (ICH) in the majority of patients. With deterioration from an initially good level of consciousness, many surgeons would agree that removal is life saving. The question is whether or not surgical removal of clot improves the ultimate outcome in patients who are stable or even improving. Improvement in function is based on the concept of a penumbra around an ICH. There is now mounting evidence that there is a penumbra of functionally impaired, but potentially reversible, neuronal injury surrounding a haematoma. A pro-active approach must, therefore, be maintained in the management of these patients to salvage as much of this brain as possible. Alert patients with small (<2 cm) haematomas and moribund patients with extensive haemorrhage may not require surgical evacuation Indications for clot removal in patients between these extremes are controversial. Current practice favours surgical intervention in the following situations: (i) superficial haemorrhage, (ii) clot volume between 20-80 ml; (iii) worsening neurological status; (iv) relatively young patients; (v) haemorrhage causing midline shift/raised ICP; and (vi) cerebellar haematomas >3 cm or causing hydrocephalus. A large multicentre prospective randomised controlled trial (International Surgical Trial in Intracerebral Haemorrhage) is currently underway to determine if early clot evacuation will lead to a better neurological outcome in patients with spontaneous supratentorial, non-aneurysmal ICH Correspondence to.

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Experimental Intracerebral Hemorrhage: Early Removal of a Spontaneous Mass Lesion Improves Late Outcome

Cited by 92 publications

References 0 publications

Endoport-assisted surgery for the management of spontaneous intracerebral hemorrhage

Endoport-assisted surgery for the management of spontaneous intracerebral hemorrhage

Gross-total hematoma removal of hypertensive basal ganglia hemorrhages: A long-term follow-up

Critical Care Management and Monitoring of Intracranial Pressure

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