Advancements in Managing Intracerebral Hemorrhage: Transition from Nihilism to Optimism
- PMID: 30888664
- DOI: 10.1007/5584_2019_351
Advancements in Managing Intracerebral Hemorrhage: Transition from Nihilism to Optimism
Abstract
There have been significant advancements in the management of intracerebral hemorrhage (ICH) stemming from new knowledge on its pathogenesis. Major clinical trials, such as Surgical Trial in Lobar Intracerebral Hemorrhage (STICH I and II), have shown only a small, albeit clinically relevant, advantage of surgical interventions in specific subsets of patients suffering from ICH. Currently, the aim is to use a minimally invasive and safe trajectory in removing significant brain hematomas with the aid of neuro-endoscopy or precise guidance through neuro-navigation, thereby avoiding a collateral damage to the surrounding normal brain tissue. A fundamental rational to such approach is to safely remove hematoma, preventing the ongoing mass effect resulting in brain herniation, and to minimize deleterious effects of iron released from hematoma to brain cells. The clot lysis process is facilitated with the adjunctive use of recombinant tissue plasminogen activator and sonolysis. Revised recommendations for the management of ICH focus on a holistic approach, with special emphasis on early patient mobilization and graded rehabilitative process. There has been a paradigm shift in the management algorithm, putting emphasis on early and safe removal of brain hematoma and then focusing on the improvement of patients' quality of life. We have made significant progress in transition from nihilism toward optimism, based on evidence-based management of such a severe global health scourge as intracranial hemorrhage.
Keywords: Brain hematoma; Brain herniation; Clinical management; Clot lysis; Intracerebral hemorrhage; Minimally invasive surgery.
Similar articles
-
Surgical Performance Determines Functional Outcome Benefit in the Minimally Invasive Surgery Plus Recombinant Tissue Plasminogen Activator for Intracerebral Hemorrhage Evacuation (MISTIE) Procedure.Neurosurgery. 2019 Jun 1;84(6):1157-1168. doi: 10.1093/neuros/nyz077. Neurosurgery. 2019. PMID: 30891610 Free PMC article. Clinical Trial.
-
Modern Approaches to Evacuating Intracerebral Hemorrhage.Curr Cardiol Rep. 2018 Oct 11;20(12):132. doi: 10.1007/s11886-018-1078-4. Curr Cardiol Rep. 2018. PMID: 30311010 Review.
-
Surgical Performance in Minimally Invasive Surgery Plus Recombinant Tissue Plasminogen Activator for Intracerebral Hemorrhage Evacuation Phase III Clinical Trial.Neurosurgery. 2017 Nov 1;81(5):860-866. doi: 10.1093/neuros/nyx123. Neurosurgery. 2017. PMID: 28402516 Free PMC article. Clinical Trial.
-
Race against the clock: overcoming challenges in the management of anticoagulant-associated intracerebral hemorrhage.J Neurosurg. 2014 Aug;121 Suppl:1-20. doi: 10.3171/2014.8.paradigm. J Neurosurg. 2014. PMID: 25081496 Review.
-
Ultra-early clot aspiration after lysis with tissue plasminogen activator in a porcine model of intracerebral hemorrhage: edema reduction and blood-brain barrier protection.J Neurosurg. 1999 Mar;90(3):491-8. doi: 10.3171/jns.1999.90.3.0491. J Neurosurg. 1999. PMID: 10067918
Cited by
-
The "SALPARE study" of spontaneous intracerebral hemorrhage: part 1.Neurol Res Pract. 2023 Feb 2;5(1):5. doi: 10.1186/s42466-023-00231-1. Neurol Res Pract. 2023. PMID: 36726162 Free PMC article.
-
Minimally Invasive Neurosurgery for Spontaneous Intracerebral Hemorrhage-10 Years of Working Progress at National Taiwan University Hospital.Front Neurol. 2022 May 20;13:817386. doi: 10.3389/fneur.2022.817386. eCollection 2022. Front Neurol. 2022. PMID: 35669873 Free PMC article.
MeSH terms
Substances
LinkOut - more resources
Full Text Sources