title: Minimally invasive surgery for intracerebral haemorrhage.
abstract: OBJECTIVE
  Spontaneous intracerebral haemorrhage (ICH) imposes a significant health and economic burden on society. Despite this, ICH remains the only stroke subtype without a definitive treatment. Without a clearly identified and effective treatment for spontaneous ICH, clinical practice varies greatly from aggressive surgery to supportive care alone. This review will discuss the current modalities of treatments for ICH including preliminary experience and investigative efforts to advance the care of these patients.
  
  
  RESULTS
  Open surgery (craniotomy), prothrombotic agents and other therapeutic interventions have failed to significantly improve the outcome of these stroke victims. Recently, the Surgical Trial in Intracerebral Haemorrhage (STICH) II assessed the surgical management of patients with superficial intraparenchymal haematomas with negative results. MISTIE II and other trials of minimally invasive surgery (MIS) have shown promise for improving patient outcomes and a phase III trial started in late 2013.
  
  
  CONCLUSIONS
  ICH lacks a definitive primary treatment as well as a therapy targeting surrounding perihematomal oedema and associated secondary damage. An ongoing phase III trial using MIS techniques shows promise for providing treatment for these patients.
authors.affiliation: Division of Neurosciences Critical Care, Departments of Neurology, Neurosurgery and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Barnes
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Hanley
authors.forename: Juan R
authors.initials: JR
authors.lastname: Carhuapoma
mesh_terms: D002543:Cerebral Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D019635:Neurosurgical Procedures / Q000379:methods*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator