Surgery for spontaneous intracerebral hemorrhage

Abstract

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.

RETRACTED ARTICLE: The risk factors of intracranial infection in patients with intracerebral hemorrhage undergone hematoma puncture: what should we care

“…Cerebral hemorrhage is one of the common clinical symptoms of cardiovascular and cerebrovascular diseases [ 1 ]. It has the characteristics of high disability rate and mortality [ 2 ]. According to statistical reports [ 3 , 4 ], death and disability caused by cerebral hemorrhage account for 33.7% patients with stroke in China.…”

Long-Term Effect of Endoscopic Evacuation for Large Basal Ganglia Hemorrhage With GCS Scores ≦ 8

“…Open craniotomy is the most studied approach in this clinical scenario. However, due to the deep location of basal ganglia, open craniotomy might cause iatrogenic damage to the healthy cerebral tissue (29). Comparing with open craniotomy, the minimally invasive surgery has much smaller interference to the surrounding normal brain tissues.…”

Diabetes does not affect motor recovery after intracerebral hemorrhage

“…Most ICHs do not require surgical treatment. However, early surgical removal of an intraparenchymal hematoma might be beneficial to reduce the mass effect, prevent or avoid midline shift, improve cerebral perfusion, and reduce the cascade of secondary brain injury [23].…”