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Surgical Treatment of Intracerebral Hemorrhage

  • Jan Vargas
  • Alejandro M. Spiotta
  • Raymond D. Turner
Chapter
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Abstract

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.

Keywords

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

  1. 1.
    Poon MT, Fonville AF, Al-Shahi Salman R. Long-term prognosis after intracerebral haemorrhage: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2014;85(6):660–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Hemphill JC 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46(7):2032–60.CrossRefPubMedGoogle Scholar
  3. 3.
    Dennis MS. Outcome after brain haemorrhage. Cerebrovasc Dis. 2003;16(Suppl 1):9–13.CrossRefPubMedGoogle Scholar
  4. 4.
    Labovitz DL, Halim A, Boden-Albala B, Hauser WA, Sacco RL. The incidence of deep and lobar intracerebral hemorrhage in whites, blacks, and Hispanics. Neurology. 2005;65(4):518–22.CrossRefPubMedGoogle Scholar
  5. 5.
    Qureshi AI, Mendelow AD, Hanley DF. Intracerebral haemorrhage. Lancet. 2009;373(9675):1632–44.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet. 2005;365(9457):387–97.CrossRefPubMedGoogle Scholar
  7. 7.
    Bhattathiri PS, Gregson B, Prasad KS, Mendelow AD, Investigators S. Intraventricular hemorrhage and hydrocephalus after spontaneous intracerebral hemorrhage: results from the STICH trial. Acta Neurochir Suppl. 2006;96:65–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet. 2013;382(9890):397–408.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Gregson BA, Broderick JP, Auer LM, Batjer H, Chen XC, Juvela S, et al. Individual patient data subgroup meta-analysis of surgery for spontaneous supratentorial intracerebral hemorrhage. Stroke. 2012;43(6):1496–504.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Luney MS, English SW, Longworth A, Simpson J, Gudibande S, Matta B, et al. Acute posterior cranial fossa hemorrhage-is surgical decompression better than expectant medical management? Neurocrit Care. 2016;25(3):365–70.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Kirollos RW, Tyagi AK, Ross SA, van Hille PT, Marks PV. Management of spontaneous cerebellar hematomas: a prospective treatment protocol. Neurosurgery. 2001;49(6):1378–86; discussion 86-7CrossRefPubMedGoogle Scholar
  12. 12.
    Xi G, Wagner KR, Keep RF, Hua Y, de Courten-Myers GM, Broderick JP, et al. Role of blood clot formation on early edema development after experimental intracerebral hemorrhage. Stroke. 1998;29(12):2580–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Lee KR, Kawai N, Kim S, Sagher O, Hoff JT. Mechanisms of edema formation after intracerebral hemorrhage: effects of thrombin on cerebral blood flow, blood-brain barrier permeability, and cell survival in a rat model. J Neurosurg. 1997;86(2):272–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Lee KR, Colon GP, Betz AL, Keep RF, Kim S, Hoff JT. Edema from intracerebral hemorrhage: the role of thrombin. J Neurosurg. 1996;84(1):91–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Wang G, Shao A, Hu W, Xue F, Zhao H, Jin X, et al. Changes of ferrous iron and its transporters after intracerebral hemorrhage in rats. Int J Clin Exp Pathol. 2015;8(9):10671–9.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Wang G, Hu W, Tang Q, Wang L, Sun XG, Chen Y, et al. Effect comparison of both iron chelators on outcomes, iron deposit, and iron transporters after intracerebral hemorrhage in rats. Mol Neurobiol. 2016;53(6):3576–85.CrossRefPubMedGoogle Scholar
  17. 17.
    Qing WG, Dong YQ, Ping TQ, Lai LG, Fang LD, Min HW, et al. Brain edema after intracerebral hemorrhage in rats: the role of iron overload and aquaporin 4. J Neurosurg. 2009;110(3):462–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Xi G, Keep RF, Hoff JT. Erythrocytes and delayed brain edema formation following intracerebral hemorrhage in rats. J Neurosurg. 1998;89(6):991–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Diringer MN, Edwards DF, Zazulia AR. Hydrocephalus: a previously unrecognized predictor of poor outcome from supratentorial intracerebral hemorrhage. Stroke. 1998;29(7):1352–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Gebel JM Jr, Jauch EC, Brott TG, Khoury J, Sauerbeck L, Salisbury S, et al. Natural history of perihematomal edema in patients with hyperacute spontaneous intracerebral hemorrhage. Stroke. 2002;33(11):2631–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Xi G, Fewel ME, Hua Y, Thompson BG Jr, Hoff JT, Keep RF. Intracerebral hemorrhage: pathophysiology and therapy. Neurocrit Care. 2004;1(1):5–18.CrossRefPubMedGoogle Scholar
  22. 22.
    Schirmer CM, Hoit DA, Malek AM. Decompressive hemicraniectomy for the treatment of intractable intracranial hypertension after aneurysmal subarachnoid hemorrhage. Stroke. 2007;38(3):987–92.CrossRefPubMedGoogle Scholar
  23. 23.
    Dierssen G, Carda R, Coca JM. The influence of large decompressive craniectomy on the outcome of surgical treatment in spontaneous intracerebral haematomas. Acta Neurochir. 1983;69(1–2):53–60.CrossRefPubMedGoogle Scholar
  24. 24.
    Ziai WC, Port JD, Cowan JA, Garonzik IM, Bhardwaj A, Rigamonti D. Decompressive craniectomy for intractable cerebral edema: experience of a single center. J Neurosurg Anesthesiol. 2003;15(1):25–32.CrossRefPubMedGoogle Scholar
  25. 25.
    Moussa WM, Khedr W. Decompressive craniectomy and expansive duraplasty with evacuation of hypertensive intracerebral hematoma, a randomized controlled trial. Neurosurg Rev. 2017;40(1):115–27.CrossRefPubMedGoogle Scholar
  26. 26.
    Auer LM, Deinsberger W, Niederkorn K, Gell G, Kleinert R, Schneider G, et al. Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study. J Neurosurg. 1989;70(4):530–5.CrossRefPubMedGoogle Scholar
  27. 27.
    Backlund EO, von Holst H. Controlled subtotal evacuation of intracerebral haematomas by stereotactic technique. Surg Neurol. 1978;9(2):99–101.PubMedGoogle Scholar
  28. 28.
    Barrett RJ, Hussain R, Coplin WM, Berry S, Keyl PM, Hanley DF, et al. Frameless stereotactic aspiration and thrombolysis of spontaneous intracerebral hemorrhage. Neurocrit Care. 2005;3(3):237–45.CrossRefPubMedGoogle Scholar
  29. 29.
    Higgins AC, Nashold BS, Cosman E. Stereotactic evacuation of primary intracerebral hematomas: new instrumentation. Appl Neurophysiol. 1982;45(4–5):438–42.PubMedGoogle Scholar
  30. 30.
    Marquardt G, Wolff R, Janzen RW, Seifert V. Basal ganglia haematomas in non-comatose patients: subacute stereotactic aspiration improves long-term outcome in comparison to purely medical treatment. Neurosurg Rev. 2005;28(1):64–9.PubMedGoogle Scholar
  31. 31.
    Mould WA, Carhuapoma JR, Muschelli J, Lane K, Morgan TC, McBee NA, et al. Minimally invasive surgery plus recombinant tissue-type plasminogen activator for intracerebral hemorrhage evacuation decreases perihematomal edema. Stroke. 2013;44(3):627–34.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Newell DW, Shah MM, Wilcox R, Hansmann DR, Melnychuk E, Muschelli J, et al. Minimally invasive evacuation of spontaneous intracerebral hemorrhage using sonothrombolysis. J Neurosurg. 2011;115(3):592–601.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Naff N, Williams MA, Keyl PM, Tuhrim S, Bullock MR, Mayer SA, et al. Low-dose recombinant tissue-type plasminogen activator enhances clot resolution in brain hemorrhage: the intraventricular hemorrhage thrombolysis trial. Stroke. 2011;42(11):3009–16.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Daverat P, Castel JP, Dartigues JF, Orgogozo JM. Death and functional outcome after spontaneous intracerebral hemorrhage. A prospective study of 166 cases using multivariate analysis. Stroke. 1991;22(1):1–6.CrossRefPubMedGoogle Scholar
  35. 35.
    Hallevi H, Albright KC, Aronowski J, Barreto AD, Martin-Schild S, Khaja AM, et al. Intraventricular hemorrhage: anatomic relationships and clinical implications. Neurology. 2008;70(11):848–52.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Fiorella D, Gutman F, Woo H, Arthur A, Aranguren R, Davis R. Minimally invasive evacuation of parenchymal and ventricular hemorrhage using the Apollo system with simultaneous neuronavigation, neuroendoscopy and active monitoring with cone beam CT. J Neurointerv Surg. 2015;7(10):752–7.CrossRefPubMedGoogle Scholar
  37. 37.
    Spiotta AM, Fiorella D, Vargas J, Khalessi A, Hoit D, Arthur A, et al. Initial multicenter technical experience with the Apollo device for minimally invasive intracerebral hematoma evacuation. Neurosurgery. 2015;11(Suppl 2):243–51; discussion 51.CrossRefPubMedGoogle Scholar
  38. 38.
    Tan LA, Lopes DK, Munoz LF, Shah Y, Bhabad S, Jhaveri M, et al. Minimally invasive evacuation of intraventricular hemorrhage with the Apollo vibration/suction device. J Clin Neurosci Off J Neurosurg Soc Australas. 2016;27:53–8.Google Scholar
  39. 39.
    Turner RD, Vargas J, Turk AS, Chaudry MI, Spiotta AM. Novel device and technique for minimally invasive intracerebral hematoma evacuation in the same setting of a ruptured intracranial aneurysm: combined treatment in the neurointerventional angiography suite. Neurosurgery. 2015;11(Suppl 2):43–50; discussion -1.PubMedGoogle Scholar
  40. 40.
    Ding D, Przybylowski CJ, Starke RM, Sterling Street R, Tyree AE, Webster Crowley R, et al. A minimally invasive anterior skull base approach for evacuation of a basal ganglia hemorrhage. J Clin Neurosci Off J Neurosurg Soc Australas. 2015;22(11):1816–9.Google Scholar
  41. 41.
    Przybylowski CJ, Ding D, Starke RM, Webster Crowley R, Liu KC. Endoport-assisted surgery for the management of spontaneous intracerebral hemorrhage. J Clin Neurosci Off J Neurosurg Soc Australas. 2015;22(11):1727–32.Google Scholar
  42. 42.
    Fiorella D, Arthur AS, Mocco JD. 305 The INVEST trial: a randomized, controlled trial to investigate the safety and efficacy of image-guided minimally invasive endoscopic surgery with Apollo vs best medical management for supratentorial intracerebral hemorrhage. Neurosurgery. 2016;63(Suppl 1):187.CrossRefGoogle Scholar
  43. 43.
    Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G. Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke. 1993;24(7):987–93.CrossRefPubMedGoogle Scholar
  44. 44.
    Wang YF, Wu JS, Mao Y, Chen XC, Zhou LF, Zhang Y. The optimal time-window for surgical treatment of spontaneous intracerebral hemorrhage: result of prospective randomized controlled trial of 500 cases. Acta Neurochir Suppl. 2008;105:141–5.CrossRefPubMedGoogle Scholar
  45. 45.
    Maila SK. Factors affecting the outcome of surgical evacuation of spontaneous deep intra cerebral bleeds. Br J Neurosurg. 2015;29(5):668–71.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

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

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