title: Treatment Strategies to Attenuate Perihematomal Edema in Patients With Intracerebral Hemorrhage.
abstract: Spontaneous intracerebral hemorrhage (SICH) continues to be a significant cause of neurologic morbidity and mortality throughout the world. Although recent advances in the treatment of SICH have significantly decreased mortality rates, functional recovery has not been dramatically improved by any intervention to date. There are 2 predominant mechanisms of brain injury from intracerebral hemorrhage: mechanical injury from the primary hematoma (including growth of that hematoma), and secondary injury from perihematomal inflammation. For instance, in the hours to weeks after SICH as the hematoma is being degraded, thrombin and iron are released and can result in neurotoxicity, free radical damage, dysregulated coagulation, and harmful inflammatory cascades; this can clinically and radiologically manifest as perihematomal edema (PHE). PHE can contribute to mass effect, cause acute neurologic deterioration in patients, and has even been associated with poor long-term functional outcomes. PHE therefore lends itself to being a potential therapeutic target. In this article, we will review 1) the pathogenesis and time course of the development of PHE, and 2) the clinical series and trials exploring various methods, with a focus on minimally invasive surgical techniques, to reduce PHE and minimize secondary brain injury. Promising areas of continued research also will be discussed.
authors.affiliation: Department of Neurosurgery, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Hoon
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery and Neurology, University of Texas Medical School at Houston, Houston, Texas, USA.
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Edwards
authors.affiliation: Department of Neurosurgery and Neurology, University of Texas Medical School at Houston, Houston, Texas, USA.
authors.forename: Huimahn A
authors.initials: HA
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery and Neurology, University of Texas Medical School at Houston, Houston, Texas, USA.
authors.forename: Tiffany R
authors.initials: TR
authors.lastname: Chang
authors.affiliation: Department of Neurosurgery, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address: jkw94@naver.com.
authors.forename: Kwang Wook
authors.initials: KW
authors.lastname: Jo
authors.affiliation: Department of Neurosurgery and Neurology, University of Texas Medical School at Houston, Houston, Texas, USA.
authors.forename: Kiwon
authors.initials: K
authors.lastname: Lee
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001929:Brain Edema / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D056424:Decompressive Craniectomy; D003676:Deferoxamine / Q000627:therapeutic use; D004234:Diuretics, Osmotic / Q000627:therapeutic use; D006801:Humans; D007036:Hypothermia, Induced; D019060:Minimally Invasive Surgical Procedures; D018696:Neuroprotective Agents / Q000627:therapeutic use; D019635:Neurosurgical Procedures; D047495:PPAR gamma / Q000819:agonists; D017262:Siderophores / Q000627:therapeutic use; D013238:Stereotaxic Techniques; D013997:Time Factors
chemical_list: D000305:Adrenal Cortex Hormones; D004234:Diuretics, Osmotic; D018696:Neuroprotective Agents; D047495:PPAR gamma; D017262:Siderophores; D003676:Deferoxamine
keywords: Brain injury; Intracerebral hemorrhage; Minimally invasive surgery; Perihematomal edema