29 Minimally Invasive Approaches for Intracerebral Hemorrhage and Intraventricular Hemorrhage
Book
Editors: Bendok, Bernard R.; Batjer, H. Hunt
Title: Hemorrhagic and Ischemic Stroke
Subtitle: Medical, Imaging, Surgical, and Interventional Approaches
Print ISBN: 9781684200436; Online ISBN: 9781684203819; Book DOI: 10.1055/b000000291
2. Edition © 2025. Thieme. All rights reserved.
Thieme Medical Publishers, Inc., New York
Subjects: Neurosurgery
Thieme Clinical Collections (English Language)
Abstract
Intracerebral hemorrhage (ICH), including intraventricular hemorrhage (IVH), is a worldwide problem without solid strategies for treatment or prevention. Ten percent to 15% of all strokes are hemorrhagic in nature representing the highest mortality rates and substantial morbidity rates of all strokes. Clinical management of ICH/IVH varies significantly and lacks a consensus-based standard of care. The Minimally Invasive Surgery with Thrombolysis in ICH Evacuation (MISTIE) and Clot Lysis Evaluation of Accelerated Resolution (CLEAR) trials represent the latest robust clinical trial evidence on minimally invasive treatment aimed at improving outcomes. In this chapter, we discuss the pathogenesis and outcome determinants, acute resuscitation and medical management, and historical open trials to better frame advances in management strategies to prevent hematoma enlargement and ultimately strategies to evacuate hematomas. New techniques and approaches are currently being investigated for safety and efficacy which we present with lessons learned along with future directions on minimally invasive management of ICH and IVH. Ongoing investigations have a high potential to change clinical practice by optimizing case selection and the surgical task with an aim of improving outcomes. Future well-designed, pragmatic clinical trials will be required to integrate the key lessons learned to finally make an impact in this devastating disease.
Key words
minimally invasive surgery - intracerebral hemorrhage - intraventricular hemorrhage - clot evacuation - Minimally Invasive Surgery and Thrombolytic Evacuation in ICH Evacuation - Clot Lysis Evaluation of Accelerated Resolution- 1 van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis.. Lancet Neurol 2010; 9 (2) 167-176 PubMed (PMID: 20056489)
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