Minimally Invasive Surgery for Intracerebral and Intraventricular Hemorrhage

Fiorella, David; Arthur, Adam S; Bain, Mark; Mocco, J

doi:10.1161/strokeaha.115.011415

Cited by 61 publications

(36 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is thought that early deterioration during the initial hours after ICH is due to hematoma expansion, whereas secondary injury results from perihematomal edema and hemotoxicity from blood degradation products 3. Trials of standard craniotomy and hematoma evacuation for spontaneous supratentorial ICH have failed to show any impact on functional outcomes or mortality 4 5.…”

Section: Introductionmentioning

confidence: 99%

“…This device was initially approved by the US Food and Drug Administration for the evacuation of ventricular hemorrhage. This indication was later expanded to include the removal of hemorrhagic products during surgery of the cerebrum 3. In the present case-control study, we analyzed our outcomes using the Penumbra Apollo system compared with best medical management alone in patients with basal-ganglia hemorrhages.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Minimally invasive endoscopic hematoma evacuation vs best medical management for spontaneous basal-ganglia intracerebral hemorrhage

Goyal

Tsivgoulis

Malhotra

et al. 2019

J NeuroIntervent Surg

Self Cite

View full text Add to dashboard Cite

BackgroundWe conducted a case-control study to assess the relative safety and efficacy of minimally invasive endoscopic surgery (MIS) for clot evacuation in patients with basal-ganglia intracerebral hemorrhage (ICH).MethodsWe evaluated consecutive patients with acute basal-ganglia ICH at a single center over a 42-month period. Patients received either best medical management according to established guidelines (controls) or MIS (cases). The following outcomes were compared before and after propensity-score matching (PSM): in-hospital mortality; discharge National Institutes of Health Stroke Scale score; discharge disposition; and modified Rankin Scale scores at discharge and at 3 months.ResultsAmong 224 ICH patients, 19 (8.5%) underwent MIS (mean age, 50.9±10.9; 26.3% female, median ICH volume, 40 (IQR, 25–51)). The interventional cohort was younger with higher ICH volume and stroke severity compared with the medically managed cohort. After PSM, 18 MIS patients were matched to 54 medically managed individuals. The two cohorts did not differ in any of the baseline characteristics. The median ICH volume at 24 hours was lower in the intervention group (40 cm3 (IQR, 25–50) vs 15 cm3 (IQR, 5–20); P<0.001). The two cohorts did not differ in any of the pre-specified outcomes measures except for in-hospital mortality, which was lower in the interventional cohort (28% vs 56%; P=0.041).ConclusionsMinimally invasive endoscopic hematoma evacuation was associated with lower rates of in-hospital mortality in patients with spontaneous basal-ganglia ICH. These findings support a randomized controlled trial of MIS versus medical management for ICH.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Minimally invasive endoscopic hematoma evacuation vs best medical management for spontaneous basal-ganglia intracerebral hemorrhage

Goyal

Tsivgoulis

Malhotra

et al. 2019

J NeuroIntervent Surg

Self Cite

View full text Add to dashboard Cite

show abstract

“…The lack of significant benefit for any specific intervention has engendered deep-seated skepticism within the neuroscience community about the potential for future research and the prospects for interventional therapies to help these patients 13 14. Moreover, low levels of reimbursement for the medical management of ICH have served as a further disincentive to both hospitals and practitioners seeking to provide care for these patients.…”

mentioning

confidence: 99%

“…A number of promising new minimally invasive devices for ICH evacuation have recently been cleared for clinical use, and a number of others are under development 14. It has been speculated that the failure of conventional surgical evacuation to benefit these patients is related to the morbidity of the open surgical approach.…”

mentioning

confidence: 99%

“…The availability of new mechanical devices designed specifically for the minimally invasive evacuation of hemorrhage has bolstered physician interest. These procedures have become easier, more generalizable, less labor intensive, and more efficient 14. Moreover, the continued development of these devices and accumulation of experience will progressively improve levels of procedural efficiency, technical efficacy, and safety.…”

mentioning

confidence: 99%

See 1 more Smart Citation