title: Treatment of intracerebral hemorrhage: a selective review and future directions.
abstract: Intracerebral hemorrhage (ICH) is a devastating disease. Sixty percent of survivors do not function independently at one year. Treatment of ICH costs approximately US$ 12.7 billion annually. To date no intervention has demonstrated clear efficacy in improving outcomes. The goal of this selective review is to provide an understanding of current treatment and discuss future directions. After a discussion of pathophysiology and societal impact, a synopsis of treatment options is reviewed, including: 1) open craniotomy; 2) catheter-based thrombolytic therapy; 3) endoscopic evacuation; and 4) ultrasonic lysis. Amongst other studies, we will discuss the results of STICH (International Surgical Trial in ICH) and MISTIE (Minimally Invasive Surgery plus Recombinant Tissue-type Plasminogen Activator for ICH Evacuation). We hope to provide a succinct, pragmatic review for the neurosurgical community on the current state of therapy and encourage novel ways to aggressively treat this burdensome disease.
authors.affiliation: Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA - nishant.ganesh.kumar@vanderbilt.edu.
authors.forename: Nishant
authors.initials: N
authors.lastname: Ganesh Kumar
authors.affiliation: Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Zuckerman
authors.affiliation: Section of Neurosurgery, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
authors.forename: Imad S
authors.initials: IS
authors.lastname: Khan
authors.affiliation: Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Dewan
authors.affiliation: Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Morone
authors.affiliation: Department of Neurosurgery, Mount Sinai Hospital, New York, NY, USA.
authors.forename: J
authors.initials: J
authors.lastname: Mocco
mesh_terms: D002543:Cerebral Hemorrhage / Q000628:therapy*; D003399:Craniotomy / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods; D006801:Humans; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome