Surgical Treatment of Intracerebral Hemorrhage

  • Jan Vargas
  • Alejandro M. SpiottaEmail author
  • Raymond D. Turner


Spontaneous intracerebral hemorrhage (ICH) is responsible for 10–15% of strokes, with a 1-year mortality rate of more than 40%. Functional independent outcome is estimated at 16.7–24.6% at 1 year following ICH. With the exception of strict blood pressure control, no medical intervention has been shown to improve outcomes for patients with spontaneous ICH. There is a lack of consensus on appropriate treatment despite the theoretical benefits of early hematoma evacuation and prevention of secondary insults following spontaneous ICH. The STITCH trials suggested that while surgery may improve outcomes in some patients with superficial lobar hemorrhages, attempts at targeting deeper lesions may disrupt viable tissue and overcome any benefits yielded by hematoma evacuation. A minimally invasive approach to the evacuation of intracranial hematomas has been a topic of interest for some time. While such approaches to hematoma evacuation have been described for several decades, advances in neuronavigation and neuroimaging have allowed for more precise placement and access of deep-seated lesions, thus minimizing the trauma to viable brain parenchyma and improving success rates. Completion of three ongoing trials (MISTIE-III, INVEST, NICO) will likely change the management of spontaneous ICH in favor of MIS evacuation.


Spontaneous Intracranial hemorrhage Minimally invasive surgery NICO Apollo MISTIE INVEST STITCH Endoscopic hematoma Evacuation 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Jan Vargas
    • 1
  • Alejandro M. Spiotta
    • 1
    Email author
  • Raymond D. Turner
    • 1
  1. 1.Department of Neurosurgery, Medical University of South CarolinaCharlestonUSA

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