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Minimally Invasive Surgery for Intracerebral Hemorrhage

  • Critical Care (SA Mayer, Section Editor)
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Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Recent success in preliminary clinical studies evaluating various forms of minimally invasive surgery for spontaneous intracerebral hemorrhage (ICH) has renewed interest in the surgical treatment of this disease process.

Recent Findings

In December of 2016, phase 2 of the Minimally Invasive Surgery Plus Rt-PA for ICH Evacuation (MISTIE) study demonstrated that this form of stereotactic thrombolysis safely reduces clot burden and may improve functional outcome 6 months after injury. A smaller arm of this study, the Intraoperative Stereotactic Computer Tomography-Guided Endoscopic Surgery (ICES) study, also demonstrated feasibility and good functional outcome for endoscopic minimally invasive evacuation.

Summary

Early-phase clinical studies evaluating various forms of minimally invasive surgery for intracerebral hemorrhage evacuation have shown safety and feasibility with a preliminary signal towards improved functional long-term outcome. Results from phase 3 studies addressing various minimally invasive techniques are imminent and will shape how intracerebral hemorrhage is treated.

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Papers of particular interest, published recently, have been highlighted as: • Of importance

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Authors and Affiliations

  1. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA

    Eliza H. Hersh, Yakov Gologorsky, Alex G. Chartrain, J Mocco & Christopher P. Kellner

Authors
  1. Eliza H. Hersh
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  2. Yakov Gologorsky
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  3. Alex G. Chartrain
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  4. J Mocco
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  5. Christopher P. Kellner
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Corresponding author

Correspondence to Christopher P. Kellner.

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Conflict of Interest

Eliza Hersh, Yakov Gologorsky, and Alex G. Chartrain each declare no potential conflicts of interest. J Mocco reports grants from Penumbra and is a consultant and investor in Rebound Therapeutics. Christopher P. Kellner reports an educational grant from Penumbra and a research grant from Siemens.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Critical Care

Electronic Supplementary Material

Video 1

In phase 1 of the SCUBA procedure, hematoma continuously presents itself to the end of the sheath and is aspirated by the Apollo device. (MOV 3956 kb)

Video 2

When brain is seen in the end of the sheath during phase 1 of the SCUBA procedure, the sheath is gently pivoted laterally at the same depth to permit more hematoma to fill the end of the sheath. (MP4 6674 kb)

Video 3

In phase 2 of the SCUBA procedure, the ICH cavity is explored for residual hematoma. (MOV 2716 kb)

Video 4

In phase 2 of the SCUBA procedure, active bleeding vessels are identified and addressed with irrigation and/or bipolar cautery. (MP4 6277 kb)

Video 5

At the conclusion of the SCUBA procedure, sufficient evacuation and hemostasis are confirmed by careful inspection of the cavity. (MP4 2375 kb)

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Hersh, E.H., Gologorsky, Y., Chartrain, A.G. et al. Minimally Invasive Surgery for Intracerebral Hemorrhage. Curr Neurol Neurosci Rep 18, 34 (2018). https://doi.org/10.1007/s11910-018-0836-4

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  • DOI: https://doi.org/10.1007/s11910-018-0836-4

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