Time to Evacuation and Functional Outcome After Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation

Kellner, Christopher P.; Song, Rui; Ali, Muhammad; Nistal, Dominic A; Samarage, Milan; Dangayach, Neha; Liang, John; McNeill, Ian T; Zhang, Xiangnan; Bederson, Joshua B.; Mocco, J

doi:10.1161/strokeaha.121.034392

Cited by 33 publications

(28 citation statements)

References 17 publications

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“…Timing of surgery has varied greatly in ICH case series, factors such as speed of diagnosis, transfer to the treating institution, delays related to consent and enrollment and operating room availability are variable in different health care system settings. Several authors have argued for faster evacuation of ICH than in prior trials, 285 while others noted that early surgery can result in higher rebleeding or less efficient ICH evacuation. 281,284,286,287…”

Section: Treatmentmentioning

confidence: 98%

Cerebral Hemorrhage: Pathophysiology, Treatment, and Future Directions

Magid-Bernstein

Girard

Polster

et al. 2022

Circulation Research

148

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Intracerebral hemorrhage (ICH) is a devastating form of stroke with high morbidity and mortality. This review article focuses on the epidemiology, cause, mechanisms of injury, current treatment strategies, and future research directions of ICH. Incidence of hemorrhagic stroke has increased worldwide over the past 40 years, with shifts in the cause over time as hypertension management has improved and anticoagulant use has increased. Preclinical and clinical trials have elucidated the underlying ICH cause and mechanisms of injury from ICH including the complex interaction between edema, inflammation, iron-induced injury, and oxidative stress. Several trials have investigated optimal medical and surgical management of ICH without clear improvement in survival and functional outcomes. Ongoing research into novel approaches for ICH management provide hope for reducing the devastating effect of this disease in the future. Areas of promise in ICH therapy include prognostic biomarkers and primary prevention based on disease pathobiology, ultra-early hemostatic therapy, minimally invasive surgery, and perihematomal protection against inflammatory brain injury.

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Section: Treatmentmentioning

confidence: 98%

Cerebral Hemorrhage: Pathophysiology, Treatment, and Future Directions

Magid-Bernstein

Girard

Polster

et al. 2022

Circulation Research

148

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“…An injury-to-cooling threshold of 12 h was recommended in an attempt to maximize the overall effect of the cooling on initial inflammation reduction. Ultimately this time point will be decided by the ability of facilities to engage in rapid diagnosis and patient transfer as well as the results of ongoing clinical studies evaluating the safety, feasibility, and efficacy of early evacuation ( 12 , 64 ). Extensive delays between the initial bleed and the subsequent evacuation and cooling may prove to substantially weaken the benefits of TH.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have suggested a potential benefit for minimally invasive surgical (MIS) evacuation, a procedure in which a small craniotomy or burr-hole is made and a device is stereo tactically guided into the blood clot to permit evacuation through a small channel under enhanced visualization ( 11 , 12 ). The benefits of MIS-ICH evacuation function primarily through the reduction of mass effect and the mitigation of the secondary effects of hematoma toxicity on the surrounding brain.…”

Section: Introductionmentioning

confidence: 99%

Consensus recommendations on therapeutic hypothermia after minimally invasive intracerebral hemorrhage evacuation from the hypothermia for intracerebral hemorrhage (HICH) working group

Baker

Kellner²,

Colbourne³

et al. 2022

Front. Neurol.

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Background and purposeTherapeutic hypothermia (TH), or targeted temperature management (TTM), is a classic treatment option for reducing inflammation and potentially other destructive processes across a wide range of pathologies, and has been successfully used in numerous disease states. The ability for TH to improve neurological outcomes seems promising for inflammatory injuries but has yet to demonstrate clinical benefit in the intracerebral hemorrhage (ICH) patient population. Minimally invasive ICH evacuation also presents a promising option for ICH treatment with strong preclinical data but has yet to demonstrate functional improvement in large randomized trials. The biochemical mechanisms of action of ICH evacuation and TH appear to be synergistic, and thus combining hematoma evacuation with cooling therapy could provide synergistic benefits. The purpose of this working group was to develop consensus recommendations on optimal clinical trial design and outcomes for the use of therapeutic hypothermia in ICH in conjunction with minimally invasive ICH evacuation.MethodsAn international panel of experts on the intersection of critical-care TH and ICH was convened to analyze available evidence and form a consensus on critical elements of a focal cooling protocol and clinical trial design. Three focused sessions and three full-group meetings were held virtually from December 2020 to February 2021. Each meeting focused on a specific subtopic, allowing for guided, open discussion.ResultsThese recommendations detail key elements of a clinical cooling protocol and an outline for the roll-out of clinical trials to test and validate the use of TH in conjunction with hematoma evacuation as well as late-stage protocols to improve the cooling approach. The combined use of systemic normothermia and localized moderate (33.5°C) hypothermia was identified as the most promising treatment strategy.ConclusionsThese recommendations provide a general outline for the use of TH after minimally invasive ICH evacuation. More research is needed to further refine the use and combination of these promising treatment paradigms for this patient population.

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“…Currently, many methods are available for the evacuation of IVH, such as catheter drainage with or without fibrinolytic therapy, neurosurgical evacuation, and minimally invasive endoscopic surgery. A recent meta-analysis[ 8 ] has reported that endoscopic evacuation is more favorable than catheter drainage. However, other researchers claim that the latter is more favorable[ 4 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic surgery for intraventricular hemorrhage: A comparative study and single center surgical experience

Wang¹,

Yuan²,

Li³

et al. 2022

WJCC

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BACKGROUND Intraventricular hemorrhage is a neurosurgical emergency, and a dangerous condition associated with high morbidity and mortality. Previously, hematoma evacuation is generally executed by external intracranial drainage (EVD) or surgical evacuation. Nowadays, endoscopic evacuation is emerging as a good alternative because it brings relatively less invasion and injury. However, successful endoscopic evacuation requires skilled manipulation of endoscopic devices and the evidence supporting its efficacy differs in different reports. AIM To improve the technique usage and provide more evidence of endoscopic evacuation efficacy, we summarize our surgical experience and compared the outcomes of the endoscopic evacuation with EVD using real-world data. METHODS We retrospectively studied 96 consecutive patients with intraventricular hemorrhage who underwent either endoscopic surgery ( n = 43) or non-endoscopic surgery ( n = 53) for hemorrhage evacuation between November 2013 and September 2019 in our center. Patients’ conditions prior to and after the operation were evaluated and analyzed to assess the efficacy of the operation. The consciousness status improvement and perioperative in-hospital parameters in the two types of operation groups were assessed and compared. RESULTS Patients in the endoscopic and non-endoscopic groups presented with a similar state of consciousness, with a comparable Glasgow Coma Scale (GCS) index. The average operation time of the endoscopic group was longer than that of the non-endoscopic group (median 2.42 h vs 1.08 h, P < 0.001). Although the endoscopic group was older and had a baseline Graeb score that indicated more severe hemorrhage than the non-endoscopic group (Graeb median: Endoscopic group = 9 vs non-endoscopic group = 8, P = 0.023), the clearance rate of hematoma was as high as 60.5%. Both the endoscopic and non-endoscopic groups showed an improved GCS index after surgery. However, this improvement was more marked in patients in the endoscopic group (median improvement of GCS index: Endoscope group = 4 vs non-endoscopic group = 1, P < 0.001). Additionally, the endoscopic group had a lower Graeb score than the non-endoscopic group after the operation. The intensive care unit stay of the endoscopic group was significantly shorter than that of the non-endoscopic group (median: endoscopic group = 6 d vs non-endoscope group = 7 d, P = 0.017). CONCLUSION Endoscopic evacuation of intraventricular hemorrhage was generally an effective and efficient way for hemorrhage evacuation, and contributed remarkably to the improvement of consciousness in patients with intraventricular hemorrhage...

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Time to Evacuation and Functional Outcome After Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation

Cited by 33 publications

References 17 publications

Cerebral Hemorrhage: Pathophysiology, Treatment, and Future Directions

Cerebral Hemorrhage: Pathophysiology, Treatment, and Future Directions

Consensus recommendations on therapeutic hypothermia after minimally invasive intracerebral hemorrhage evacuation from the hypothermia for intracerebral hemorrhage (HICH) working group

Endoscopic surgery for intraventricular hemorrhage: A comparative study and single center surgical experience

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