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Surgical Management of Spontaneous Intracerebral Hemorrhage

  • Critical Care Neurology (H Hinson, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Abstract

Purpose of review

This review presents the current evidence and recommendations regarding surgical management of spontaneous intracerebral hemorrhage (ICH). In particular, we discuss the emerging minimally invasive surgical techniques and provide a surgical decision-making algorithm based on current evidence for the practicing clinician.

Recent findings

Hematoma evacuation is an attractive strategy to relieve mass effect, reduce intracranial pressure, and prevent secondary ongoing tissue injury and thereby reduce mortality and improve outcome. Enthusiasm for open surgical techniques such as craniotomy with clot evacuation waned after two large pragmatic trials failed to demonstrate superiority for good functional outcome. Minimally invasive surgical (MIS) strategies such as endoscopic evacuation and stereotactic aspiration ± thrombolysis are safe, have less operative morbidity, and probably have a mortality benefit but clear evidence of functional benefit has not been shown yet. In the last decade, the advent of newer minimally invasive devices in combination with novel imaging and navigation tools has facilitated several ongoing randomized trials to answer this elusive question.

Summary

With careful patient selection and ongoing advances in MIS, it is anticipated that in the next few years, one or more of the MIS techniques will become the standard for surgical management of both lobar and deep ICH.

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Authors and Affiliations

  1. Division of Neurocritical Care, Department of Neurology, Stanford University, Stanford, CA, USA

    Sandeep Walia MD

  2. Department of Neurology, Stanford University, Stanford, CA, USA

    Kirsten Fisher MD

  3. Department of Neurosurgery, Stanford University, Stanford, CA, USA

    Robert L. Dodd MD, PhD

  4. Division of Neurocritical Care, Division of Stroke, Department of Neurology, Stanford University, Stanford, CA, USA

    Chitra Venkatasubramanian MBBS, MD, MSc, FNCS

  5. Stanford Stroke Center, 453 Quarry Road, Palo Alto, CA, 94304, USA

    Chitra Venkatasubramanian MBBS, MD, MSc, FNCS

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  1. Sandeep Walia MD
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  2. Kirsten Fisher MD
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  4. Chitra Venkatasubramanian MBBS, MD, MSc, FNCS
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Correspondence to Chitra Venkatasubramanian MBBS, MD, MSc, FNCS.

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Walia, S., Fisher, K., Dodd, R.L. et al. Surgical Management of Spontaneous Intracerebral Hemorrhage. Curr Treat Options Neurol 23, 28 (2021). https://doi.org/10.1007/s11940-021-00678-0

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