Intracerebral Hemorrhage: Keep It Simple

Daniel F. Hanley, Wendy C. Ziai, Farhaan S. Vahidy, Sean Polster, Nichol A. McBee, Richard E. Thompson, Issam A. Awad

Research output: Contribution to journalReview articlepeer-review

Abstract

The quotation, attributed to Confucius many centuries ago, in our opinion, applies to the evolving story of defining a primary surgical treatment for spontaneous intracerebral hemorrhage. The precise quote is: "Keep it simple and focus on what matters. Don't let yourself be overwhelmed."1 The evidence from multiple trials on intracerebral hemorrhage regarding mortality benefit and potential functional benefit directs us toward the simple task of evacuating the clot, similar to our prime focus on opening the artery in ischemic stroke. We need not be overwhelmed by questions about adjustments to patient selection, comparative techniques, and precision timing, for which we do not have conclusive data. We review the consensus results from the recent MISTIE trial (Minimally Invasive Surgery Plus Alteplase in ICH Evacuation) and ENRICH trial (Early Minimally Invasive Removal of Intracerebral Hemorrhage) and articulate remaining questions where further evidence is needed to challenge equipoise and define future practice.

Original languageEnglish (US)
Pages (from-to)2942-2945
Number of pages4
JournalStroke
Volume55
Issue number12
DOIs
StatePublished - Dec 1 2024

Keywords

  • cerebral hemorrhage
  • infarction
  • minimally invasive surgical procedures
  • neurosurgery
  • stroke
  • tissue preservation

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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