WSC 2022 | Advances in surgical intracerebral hemorrhage management

Shahid Nimjee, MD, PhD, The Ohio State College of Medicine, Columbus, OH, shares an overview of current standards and recent advances in neurosurgical intracerebral hemorrhage (ICH) management. A lack of prospective, randomized data to support the role of hematoma evacuation has led to substantial variability in current surgical standards and thus, ideal management is still to be determined. There is some data to support the potential benefits of surgical drainage; several small case series have shown patients who undergo surgery to spend less time in intensive care, be extubated more quickly, and be discharged sooner than those who do not. However, most surgical ICH trials to date have failed to show improved outcomes after ICH with surgical intervention. The greatest focus in the neurosurgical field is optimizing minimally invasive techniques and developing navigation-based technology to minimize surgery risk. Endoscopic and exoscopic hematoma evacuation are both being used to reach deep bleeds, while causing minimal surgical trauma to the normal brain tissue in the process. Several clinical trials are underway to shed light on this topic, including ENRICH (Early Minimally-Invasive Removal of Intracerebral Hemorrhage) and INVEST (Minimally Invasive Endoscopic Surgical Treatment With Apollo/Artemis in Patients With Brain Hemorrhage). This interview took place at the World Stroke Congress 2022 in Singapore.

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