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Journal of Neurosurgical Sciences 2017 October;61(5):523-35

DOI: 10.23736/S0390-5616.16.03661-4

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Treatment of intracerebral hemorrhage: a selective review and future directions

Nishant GANESH KUMAR 1 , Scott L. ZUCKERMAN 1, Imad S. KHAN 2, Michael C. DEWAN 1, Peter J. MORONE 1, J. MOCCO 3

1 Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA; 2 Section of Neurosurgery, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; 3 Department of Neurosurgery, Mount Sinai Hospital, New York, NY, USA


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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.


KEY WORDS: Hypertensive intracranial hemorrhage - Blood coagulation - Traumatic cerebral hemorrhage - Thrombolytic therapy

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