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Current Neurology and Neuroscience Reports
Published in: Current Neurology and Neuroscience Reports 6/2018

01-06-2018 | Critical Care (SA Mayer, Section Editor)

Minimally Invasive Surgery for Intracerebral Hemorrhage

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

Published in: Current Neurology and Neuroscience Reports | Issue 6/2018

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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.
Appendix
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Literature
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;9:167–76.CrossRefPubMed
2.
An SJ, Kim TJ, Yoon B-W. Epidemiology, risk factors, and clinical features of intracerebral hemorrhage: an update. J Stroke Cerebrovasc Dis. 2017;19:3–10.
3.
4.
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;46:2032–60.CrossRefPubMed
5.
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;365:387–97.CrossRefPubMed
6.
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;382:397–408.CrossRefPubMedPubMedCentral
7.
8.
Doi E, Moriwaki H, Komai N, Iwamoto M. Stereotactic evacuation of intracerebral hematomas. Neurol Med Chir. 1982;22:461–7.CrossRef
9.
Matsumoto K, Hondo H. CT-guided stereotaxic evacuation of hypertensive intracerebral hematomas. J Neurosurg. 1984;61:440–8.CrossRefPubMed
10.
Niizuma H, Otsuki T, Katakura R, Suzuki J. Aspiration of intracerebral hematomas and biopsy of deep brain tumors using CT-guided stereotaxic technique. Surgery in and around the Brain Stem and the Third Ventricle. 1986. p. 534–9.
11.
Teernstra OPM, Evers SMAA, Lodder J, Leffers P, Franke CL, Blaauw G, et al. Stereotactic treatment of intracerebral hematoma by means of a plasminogen activator: a multicenter randomized controlled trial (SICHPA). Stroke. 2003;34:968–74.CrossRefPubMed
12.
Morgan T, Zuccarello M, Narayan R, Keyl P, Lane K, Hanley D. Preliminary findings of the minimally-invasive surgery plus rtPA for intracerebral hemorrhage evacuation (MISTIE) clinical trial. Acta Neurochirurgica Supplementum. p. 147–51.
13.
• Hanley DF, Thompson RE, Muschelli J, Rosenblum M, McBee N, Lane K, et al. Safety and efficacy of minimally invasive surgery plus alteplase in intracerebral haemorrhage evacuation (MISTIE): a randomised, controlled, open-label, phase 2 trial. Lancet Neurol. 2016;15:1228–37. The MISTIE trial is a phase 2 study evaluating stereotactic thrombolysis in spontaneous ICH that demonstrated efficacy of the procedure with a decrease in clot burden as well as with preliminary evidence of a functional benefit at 6-month follow-up. CrossRefPubMedPubMedCentral
14.
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;44:627–34.CrossRefPubMedPubMedCentral
15.
Fam MD, Hanley D, Stadnik A, Zeineddine HA, Girard R, Jesselson M, et al. Surgical performance in minimally invasive surgery plus recombinant tissue plasminogen activator for intracerebral hemorrhage evacuation phase iii clinical trial. Neurosurgery [Internet]. 2017; Available from: https://​doi.​org/​10.​1093/​neuros/​nyx123
16.
Wang W-Z, Jiang B, Liu H-M, Li D, Lu C-Z, Zhao Y-D, et al. Minimally invasive craniopuncture therapy vs. conservative treatment for spontaneous intracerebral hemorrhage: results from a randomized clinical trial in China. Int J Stroke. 2009;4:11–6.CrossRefPubMed
17.
Wang J-W, Li J-P, Song Y-L, Tan K, Wang Y, Li T, et al. Stereotactic aspiration versus craniotomy for primary intracerebral hemorrhage: a meta-analysis of randomized controlled trials. PLoS One. 2014;9:e107614.CrossRefPubMedPubMedCentral
18.
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. 2015;22:1816–9.CrossRefPubMed
19.
Przybylowski CJ, Ding D, Starke RM, Webster Crowley R, Liu KC. Endoport-assisted surgery for the management of spontaneous intracerebral hemorrhage. J Clin Neurosci. 2015;22:1727–32.CrossRefPubMed
20.
• Labib MA, Shah M, Kassam AB, Young R, Zucker L, Maioriello A, et al. The safety and feasibility of image-guided brainpath-mediated transsulcul hematoma evacuation: a multicenter study. Neurosurgery. 2017;80:515–24. This feasibility study demonstrates reliable clot evacuation with good functional outcome in a multicenter study evaluating emergent clot evacuation using the BrainPath endoport. PubMed
21.
Kim YZ, Kim KH. Even in patients with a small hemorrhagic volume, stereotactic-guided evacuation of spontaneous intracerebral hemorrhage improves functional outcome. J Korean Neurosurg Soc. 2009;46:109–15.CrossRefPubMedPubMedCentral
22.
Nagasaka T, Tsugeno M, Ikeda H, Okamoto T, Inao S, Wakabayashi T. A novel monoshaft bipolar cautery for use in endoscopic intracranial surgery. A short technical note. Clin Neurol Neurosurg. 2011;113:607–11.CrossRefPubMed
23.
Nagasaka T, Tsugeno M, Ikeda H, Okamoto T, Takagawa Y, Inao S, et al. Balanced irrigation-suction technique with a multifunctional suction cannula and its application for intraoperative hemorrhage in endoscopic evacuation of intracerebral hematomas: technical note. Neurosurgery. 2009;65:E826–7. discussion E827CrossRefPubMed
24.
Nagasaka T, Tsugeno M, Ikeda H, Okamoto T, Inao S, Wakabayashi T. Early recovery and better evacuation rate in neuroendoscopic surgery for spontaneous intracerebral hemorrhage using a multifunctional cannula: preliminary study in comparison with craniotomy. J Stroke Cerebrovasc Dis. 2011;20:208–13.CrossRefPubMed
25.
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;70:530–5.CrossRefPubMed
26.
• Vespa P, Hanley D, Betz J, Hoffer A, Engh J, Carter R, et al. ICES (Intraoperative Stereotactic Computed Tomography-Guided Endoscopic Surgery) for Brain Hemorrhage: A Multicenter Randomized Controlled Trial. Stroke. 2016;47:2749–55. The ICES trial is an arm of the MISTIE trial that randomized 14 patients to undergo endoscopic minimally invasive surgery for ICH evacuation and demonstrated good clot evacuation with preliminary evidence of a functional benefit at 6-month follow-up. CrossRefPubMedPubMedCentral
27.
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 2:243–251; discussion 251.
28.
Kellner CP, Chartrain AG, Nistal DA, Scaggiante J, Hom D, Ghatan S, et al. The stereotactic intracerebral hemorrhage underwater blood aspiration (SCUBA) technique for minimally invasive endoscopic intracerebral hemorrhage evacuation. J Neurointerv Surg [Internet]. 2018. https://​doi.​org/​10.​1136/​neurintsurg-2017-013719
Metadata
Title
Minimally Invasive Surgery for Intracerebral Hemorrhage
Authors
Eliza H. Hersh
Yakov Gologorsky
Alex G. Chartrain
J Mocco
Christopher P. Kellner
Publication date
01-06-2018
Publisher
Springer US
Published in
Current Neurology and Neuroscience Reports / Issue 6/2018
Print ISSN: 1528-4042
Electronic ISSN: 1534-6293
DOI
https://doi.org/10.1007/s11910-018-0836-4

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