Optimal time window for minimally invasive surgery in treating spontaneous intracerebral hemorrhage in the basal ganglia region: a multicenter and retrospective study

Xiao, Kaimin; Chu, Hang; Chen, Hongmei; You-an, Zhong; Zhong, Lintao; Tang, Yuping

doi:10.1080/02688697.2020.1854682

Cited by 3 publications

(4 citation statements)

References 23 publications

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“…[379][380][381][382][383][384][385][386][387][388]391,392 The present guideline uses primarily data from the largest RCT of MIS (MISTIE III), 381 meta-analyses of trials comparing MIS with conventional craniotomy and standard medical care, 379,380,[382][383][384][385][386][387][388][389][390][393][394][395] and smaller RCTs. 391,392,[396][397][398][399][400][401][402][403][404][405][406][407][408][409][410][411][412] The majority of clinical trials have used ICH volume thresholds of >20 or >30 mL as an inclusion criterion. As a primary recommendation, minimally invasive hematoma evacuation with endoscopic or stereotactic aspiration, with or without thrombolytic use, is safe and m...…”

Section: Cor Loe Recommendations 2a B-rmentioning

confidence: 99%

2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association

Greenberg¹,

Ziai²,

Cordonnier³

et al. 2022

Stroke

578

472

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other entities (RWI) can be found at https://professional. heart.org/-/media/phd-files/guidelines-and-statements/ policies-devolopment/aha-asa-disclosure-rwi-policy-5118. pdf?la=en.Beginning in 2017, numerous modifications to AHA/ ASA guidelines have been implemented to make guidelines shorter and enhance user-friendliness. Guidelines are written and presented in a modular knowledge chunk format; each chunk includes a table of recommendations, a brief synopsis, recommendation-specific supportive text, and, when appropriate, flow diagrams or additional tables. Hyperlinked references are provided to facilitate quick access and review. Other modifications to the guidelines include the addition of Knowledge Gaps and Future Research segments in some sections and a web guideline supplement (Online Data Supplement) for useful but noncritical tables and figures.

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Section: Cor Loe Recommendations 2a B-rmentioning

confidence: 99%

2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association

Greenberg¹,

Ziai²,

Cordonnier³

et al. 2022

Stroke

578

472

View full text Add to dashboard Cite

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“…In the future, to pursue better surgical results, an effort should be made to increase the rate of evacuation or the accuracy of the approach. Whether it is based on cautious patient selection ( 25 ), ultra-early evacuation ( 26 ), refinement of the surgical technique, association of neuroprotectives ( 27 ) or use of mechanical adjuvants to ease hematoma disaggregation, like sonothrombolysis ( 28 ) or transcranial histotripsy ( 29 ). Moreover, advances in the endoscopic ports have also been pursued to minimize white matter disruption ( 30 ), and robot assisted surgery has been developed to increase the accuracy in stereotactic placement of the catheter ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Surgery for Spontaneous Intracerebral Hematoma. Real-Life Implementation Model and Economic Estimation

et al. 2022

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ObjectiveSpontaneous intracerebral hemorrhage is characterized by high fatality outcomes, even under best medical treatment. Recently, minimally invasive surgical (MIS) evacuation of the hematoma has shown promising results and may soon be implemented in the clinical practice. Hereby, we intended to foresee the logistic requirements for an early hematoma evacuation protocol, as well as to evaluate in a real-life implementation model the cost-utility of the two main MIS techniques for hemorrhagic stroke (catheter evacuation plus thrombolysis and neuroendoscopic aspiration).MethodsData were obtained from the pool of hemorrhagic-stroke patients admitted to our institution during an annual period (2020–2021) and contrasted to the reported results in published trials of MIS techniques. Potential candidates for surgical treatment were identified according to the inclusion/exclusion criteria established in these trials. Then, a cost-utility analysis was performed, which explored the incremental cost per unit of health gained with a given treatment. The treatment effect was measured by differences in modified Rankin Score, and subsequently converted to quality-adjusted life years (QALY).ResultsOf the 137 patients admitted to our center with supratentorial spontaneous intracerebral hemorrhage in a 1-year period, 17 (12.4%) were potential candidates for the catheter evacuation plus thrombolysis technique (Minimally Invasive Surgery with Thrombolysis in Intracerebral Hemorrhage Evacuation trial, MISTIE III criteria) and 59 (43.0%) for the neuroendoscopic aspiration technique (Dutch Intracerebral Hemorrhage Surgery Trial Pilot Study, DIST criteria). The incremental cost-utility ratio was € 76,533.13 per QALY for the catheter-based evacuation and € 60,703.89 per QALY for the endoscopic-based technique.ConclusionAround 12–43% of patients admitted to hospital with spontaneous hemorrhagic stroke could be potential candidates to MIS early evacuation of the cerebral hematoma. In our real-life implementation model, the cost-utility analysis favored the neuroendoscopic evacuation over the catheter aspiration technique. Further studies are advisable as new data from the ongoing randomized trials becomes available.

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“…The most common causes of intracerebral hematomas are hypertensive, vascular, and hemorrhages secondary to amyloid deposition (5). Although the use of a minimally invasive hematoma drainage treatment for hypertensive hematomas can be observed in the basal ganglia, which generally causes low GCS scores, serious neurological deficits, and very poor prognosis, DC is still the most used method worldwide (6). In intracerebral hematomas, perihematomal edema increases by 75% in the first 24 h (6).…”

Section: Discussionmentioning

confidence: 99%

“…In intracerebral hematomas, perihematomal edema increases by 75% in the first 24 h (6). One of the reasons why DC is the most preferred method for the surgical treatment of intracerebral hematoma is because of its effectiveness in eliminating the compression effect regardless of the location of the hematoma (6). Despite this, there is still no clear consensus on regulations that will increase their survival.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Survival of Patients Who Underwent Decompressive Craniectomy: Clinical Series

Ekiz¹,

Barut²,

Haşimoğlu³

et al. 2021

csmedj

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Objective: This study aimed to examine the parameters thought to reduce the mortality of patients with epidural-subdural hemorrhage, basal ganglia hemorrhage, edema with compression effect due to intracerebral ischemic infarction, and hemorrhage from infarcts and to find significant relationships accordingly. Material and Methods:The demographic and clinical characteristics of patients, pre-operative Glasgow Coma scale (GCS), duration of the operation after the development of the first event, length of stay in intensive care units (ICUs), infection and antibiotic therapy rates developed during their hospitalization, and long-term follow-up were recorded. The survival of the patients were compared statistically. Results:In 38 patients with GCS less than 10 points, pre-operative GCS, length of stay in ICUs, duration of mechanical ventilator support, infection, and need for antibiotic therapy were examined. All patients were divided into four groups; subdural-epidural hematoma, intracerebral hematoma, intracerebral ischemic infarction, and post-infarction hemorrhage groups. The relationship between their data and mortality were studied. The pre-operative GCS scores in the four groups were 6.16, 6.73, 7.13, and 6.28, respectively. The pre-operative GCS in these four dead groups were 5, 6.6, 7, and 6, respectively. There was no difference between the variables and mortality. Conclusion:No correlation was found between all clinical data and survival rates. The benefits of an early surgery shown in previous studies were not associated with mortality in this study. Studies with larger case series are needed for more significant relationships.

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Optimal time window for minimally invasive surgery in treating spontaneous intracerebral hemorrhage in the basal ganglia region: a multicenter and retrospective study

Cited by 3 publications

References 23 publications

2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association

2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association

Minimally Invasive Surgery for Spontaneous Intracerebral Hematoma. Real-Life Implementation Model and Economic Estimation

Evaluation of Survival of Patients Who Underwent Decompressive Craniectomy: Clinical Series

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