title: Spontaneous intracerebral and intraventricular hemorrhage: advances in minimally invasive surgery and thrombolytic evacuation, and lessons learned in recent trials.
abstract: Optimal management of spontaneous intracerebral hemorrhage (ICH) remains one of the highly debated areas in the field of neurosurgery. Earlier studies comparing open surgical intervention with best medical management failed to show a clear benefit. More recent experience with minimally invasive techniques has shown greater promise. Well-designed phase II trials have confirmed the safety and preliminary treatment effect of thrombolytic aspiration and clearance of spontaneous ICH and associated intraventricular obstructive hemorrhage. Those trials are reviewed, including respective protocols and technical nuances, and lessons learned regarding patient selection, the concept of hemorrhage stabilization, optimization of the surgical procedure, and thrombolytic dosing decisions. These concepts have been incorporated in the design of ongoing definite phase III randomized trials (MISTIE and CLEAR) funded by the National Institutes of Health. These are presented including the role of surgical leadership in the training and monitoring of the surgical task and quality assurance. The impact of these techniques on neurosurgical practice is discussed.
authors.affiliation: Hemorrhagic Stroke Research Unit, Section of Neurosurgery and the Neurovascular Surgery Program, University of Chicago Medicine and Biological Sciences, Chicago, Illinois.
authors.forename: Mahua
authors.initials: M
authors.lastname: Dey
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Stadnik
authors.forename: Issam A
authors.initials: IA
authors.lastname: Awad
mesh_terms: D002543:Cerebral Hemorrhage / Q000503:physiopathology / Q000628:therapy*; D002986:Clinical Trials as Topic; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D015912:Thrombolytic Therapy
chemical_list: D005343:Fibrinolytic Agents