Spontaneous Intracerebral Hemorrhage: Should We Operate?

Babi, Marc-Alain; James, Michael L.

doi:10.3389/fneur.2017.00645

Cited by 17 publications

(9 citation statements)

References 14 publications

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“…Although the role of open surgery to treat patients with spontaneous ICH remains controversial, the use of craniotomy for supratentorial hematoma drainage is the most common strategy applied in most centers and also the most studied approach so far (Figs. 2, 3, and 4) [29,30].…”

Section: Craniotomy For Supratentorial Hemorrhage Drainagementioning

confidence: 99%

Surgery for spontaneous intracerebral hemorrhage

2020

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Spontaneous intracerebral hemorrhage is a devastating disease, accounting for 10 to 15% of all types of stroke; however, it is associated with disproportionally higher rates of mortality and disability. Despite significant progress in the acute management of these patients, the ideal surgical management is still to be determined. Surgical hematoma drainage has many theoretical benefits, such as the prevention of mass effect and cerebral herniation, reduction in intracranial pressure, and the decrease of excitotoxicity and neurotoxicity of blood products.Several surgical techniques have been considered, such as open craniotomy, decompressive craniectomy, neuroendoscopy, and minimally invasive catheter evacuation followed by thrombolysis. Open craniotomy is the most studied approach in this clinical scenario, the first randomized controlled trial dating from the early 1960s. Since then, a large number of studies have been published, which included two large, well-designed, well-powered, multicenter, multinational, randomized clinical trials. These studies, The International Surgical Trial in Intracerebral Hemorrhage (STICH), and the STICH II have shown no clinical benefit for early surgical evacuation of intraparenchymal hematoma in patients with spontaneous supratentorial hemorrhage when compared with best medical management plus delayed surgery if necessary. However, the results of STICH trials may not be generalizable, because of the high rates of patients’ crossover from medical management to the surgical group. Without these high crossover percentages, the rates of unfavorable outcome and death with conservative management would have been higher. Additionally, comatose patients and patients at risk of cerebral herniation were not included. In these cases, surgery may be lifesaving, which prevented those patients of being enrolled in such trials. This article reviews the clinical evidence of surgical hematoma evacuation, and its role to decrease mortality and improve long-term functional outcome after spontaneous intracerebral hemorrhage.

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Section: Craniotomy For Supratentorial Hemorrhage Drainagementioning

confidence: 99%

Surgery for spontaneous intracerebral hemorrhage

2020

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“…While the GCS score was not primarily intended to be used in ICH, its role as a predictor of ICH outcome has been previously established [14,27]. We chose the GCS interval for inclusion in the study between 7 to 13 points, as in our institution, we do not consider suitable surgical candidates patients with ICH and GCS ≤ 6 or patients with good neurological status having GCS ≥ 14.…”

Section: Discussionmentioning

confidence: 99%

“…However, the role of surgery in ICH treatment remains controversial as two major, international, randomized studies (STICH I and STICH II) were unable to identify any apparent benefits of surgery over the medical treatment in ICH [11][12][13]. Recently, these studies, due to their patient selection structure, have been challenged [14,15], deciding to undertake surgery being a continued matter of debate [16].…”

Section: Introductionmentioning

confidence: 99%

Effects of Surgery on the 30-Day Survival Rate in Spontaneous Supratentorial Intracerebral Hemorrhage

Bălaşa

Ghiga

Andone³

et al. 2020

Brain Sciences

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Background: Spontaneous intracerebral hemorrhage (ICH) is a severe form of stroke. The efficacy of surgery as ICH treatment is controversial. We sought to compare the 30-day postoperative mortality rate between patients with surgically and medically treated ICH; Methods: This prospective study enrolled patients consecutively diagnosed with ICH and treated between 2017 and 2019. Patients meeting the study surgical indications were assigned to either surgical or medical treatment. The relationship between Glasgow Coma Scale (GCS) score, age, ICH location, ICH volume, and 30-day mortality was analyzed. Results: A total of 174 ICH patients were enrolled in this study. Of these, 136 met the surgery criteria; 65 of these underwent surgery (Group A), and 71 received medical treatment (Group B). Age and ICH location did not modify mortality. Although surgery did not overall improve mortality some better postsurgical outcomes were observed among patients surgically treated with GCS scores of at least 10 points and ICH volumes between 30 to 50 mL; Conclusions: Despite achieving an immediate reduction in intracranial pressure, surgery seems to be advantageous only for patients with ICH volumes between 30 to 50 mL and GCS scores of 10 points or higher;

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“…Although the approach of open surgery to treat patients with cerebral hemorrhage remains controversial, it is still one of the most common approaches applied for hematoma drainage. 121 The Surgical Trial in Intracerebral Hemorrhage (STICH), which was the first multicenter, multinational, randomized clinical trial that compared the benefits of hematoma drainage with conservative management, found that there was no overall benefit from early hematoma drainage compared with conservative treatment. 122 Subsequently, another international, multicenter, prospective, randomized trial, which included only patients with superficial hematomas within 1 cm from the brain's cortical surface of the brain, indicated that patients with superficial hematomas could benefit from early intervention of hematoma removal.…”

Section: Open Surgerymentioning

confidence: 99%