Surgical management of spontaneous intracerebral hemorrhage

insights from randomized controlled trials

Robert C. Rennert, Kathryn Tringale, Jeffrey A. Steinberg, Peter Warnke, Isha Konety, Lauren Albert Sand, Navaz Karanjia, Ramu Tummala, Clark C Chen

Research output: Contribution to journalReview article

Abstract

Spontaneous intracerebral hemorrhages (ICH) are a major cause of neurologic morbidity and mortality. The optimal management strategy of ICH remains controversial. We examine the available randomized controlled trial (RCT) data regarding neurosurgical evacuation of ICHs. A systematic literature review on surgical evacuation of spontaneous ICHs was performed to identify pertinent RCT data published between 1980 and 2019. We identified five RCTs that assessed the clinical impact of evacuation of spontaneous ICHs. Data from two high-quality RCTs randomizing 1033 and 601 patients with spontaneous ICHs (Surgical Trial in Intracerebral Hemorrhage (STICH) I and II) (1) failed to demonstrate a significant clinical benefit of routine open surgical evacuation of spontaneous cortical ICHs and (2) reinforced the high morbidity and mortality associated with ICH. These trials were nonetheless limited by high (> 20%) crossover from the medical to surgical arms. Data from three smaller RCTs on minimally invasive (stereotactic and endoscopic) surgical approaches randomizing 377, 242, and 100 patients with spontaneous ICHs suggest potential benefits relating to mortality and functional outcomes in patients with subcortical ICHs. While these RCTs do not clearly define the role of surgical resection for ICHs, they provide insights into opportunities for patient advocacy, clinical trial design, and future research studies. Ongoing studies building upon the potential for minimally invasive approaches for ICH evacuation may expand the surgical indications for ICH.

Original languageEnglish (US)
JournalNeurosurgical Review
DOIs
StatePublished - Jan 1 2019

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Cerebral Hemorrhage
Randomized Controlled Trials
Mortality
Morbidity
Patient Advocacy
Nervous System
Clinical Trials

Keywords

  • Hemorrhagic stroke
  • Spontaneous intracerebral hemorrhage
  • Surgical evacuation

PubMed: MeSH publication types

  • Journal Article
  • Review

Cite this

Surgical management of spontaneous intracerebral hemorrhage : insights from randomized controlled trials. / Rennert, Robert C.; Tringale, Kathryn; Steinberg, Jeffrey A.; Warnke, Peter; Konety, Isha; Sand, Lauren Albert; Karanjia, Navaz; Tummala, Ramu; Chen, Clark C.

In: Neurosurgical Review, 01.01.2019.

Research output: Contribution to journalReview article

Rennert, Robert C. ; Tringale, Kathryn ; Steinberg, Jeffrey A. ; Warnke, Peter ; Konety, Isha ; Sand, Lauren Albert ; Karanjia, Navaz ; Tummala, Ramu ; Chen, Clark C. / Surgical management of spontaneous intracerebral hemorrhage : insights from randomized controlled trials. In: Neurosurgical Review. 2019.
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