Indication, Timing, and Surgical Treatment of Spontaneous Intracerebral Hemorrhage: Systematic Review and Proposal of a Management Algorithm

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Abstract

Objective: To delineate the most recommendable treatment of spontaneous intracerebral hemorrhages and the indication for surgery, its timing, and the best surgical technique to be adopted case by case. Methods: Based on PubMed/MEDLINE, Embase, and the Cochrane Library databases, a systematic review of the literature was performed using as keywords the terms “spontaneous intracerebral hemorrhage,” “surgical management,”, “medical management,” “supratentorial,”, and “infratentorial.” Because of the highest level of evidence, only randomized and nonrandomized clinical trials, meta-analyses, and comparative cohort studies reported within the last 12 years were selected. An updated and evidence-based treatment algorithm was reported also. Results: The search initially returned 255 articles. After application of the exclusion criteria, only 19 studies were selected. According to the site and volume of the hematoma, admission Glasgow Coma Scale (GCS) score, and progressive neurologic decline, specific subgroups were identified. Surgery must be considered in patients with an admission GCS score ranging between 5 and 12 and a hematoma volume >30 mL. The best time-window has been reported to be 7–24 hours after ictus. Endoscopic surgery is recommendable for patients with a supratentorial hematoma >60 mL and with a poor GCS score (4–8). Alternative techniques, such as minimally invasive puncture and thrombolysis, may be considered for deeper hematoma. Conclusions: Careful selection of patients eligible for surgery is mandatory. The optimal timing falls into a time-window ranging between 7 and 24 hours after ictus. Minimal invasive techniques are valuable surgical options for patients in a poor GCS score or harboring large deep-seated hemorrhages.

Original languageEnglish
JournalWorld Neurosurgery
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Glasgow Coma Scale
Cerebral Hemorrhage
Hematoma
Patient Admission
Therapeutics
Punctures
PubMed
MEDLINE
Patient Selection
Nervous System
Libraries
Meta-Analysis
Cohort Studies
Randomized Controlled Trials
Databases
Hemorrhage

Keywords

  • Hemorrhagic stroke
  • Intracerebral hematoma
  • Intracerebral hemorrhage
  • Minimal invasive surgery
  • Stroke management

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

@article{248a257f12844e5680d5dfa6e7b13fad,
title = "Indication, Timing, and Surgical Treatment of Spontaneous Intracerebral Hemorrhage: Systematic Review and Proposal of a Management Algorithm",
abstract = "Objective: To delineate the most recommendable treatment of spontaneous intracerebral hemorrhages and the indication for surgery, its timing, and the best surgical technique to be adopted case by case. Methods: Based on PubMed/MEDLINE, Embase, and the Cochrane Library databases, a systematic review of the literature was performed using as keywords the terms “spontaneous intracerebral hemorrhage,” “surgical management,”, “medical management,” “supratentorial,”, and “infratentorial.” Because of the highest level of evidence, only randomized and nonrandomized clinical trials, meta-analyses, and comparative cohort studies reported within the last 12 years were selected. An updated and evidence-based treatment algorithm was reported also. Results: The search initially returned 255 articles. After application of the exclusion criteria, only 19 studies were selected. According to the site and volume of the hematoma, admission Glasgow Coma Scale (GCS) score, and progressive neurologic decline, specific subgroups were identified. Surgery must be considered in patients with an admission GCS score ranging between 5 and 12 and a hematoma volume >30 mL. The best time-window has been reported to be 7–24 hours after ictus. Endoscopic surgery is recommendable for patients with a supratentorial hematoma >60 mL and with a poor GCS score (4–8). Alternative techniques, such as minimally invasive puncture and thrombolysis, may be considered for deeper hematoma. Conclusions: Careful selection of patients eligible for surgery is mandatory. The optimal timing falls into a time-window ranging between 7 and 24 hours after ictus. Minimal invasive techniques are valuable surgical options for patients in a poor GCS score or harboring large deep-seated hemorrhages.",
keywords = "Hemorrhagic stroke, Intracerebral hematoma, Intracerebral hemorrhage, Minimal invasive surgery, Stroke management",
author = "Sabino Luzzi and Angela Elia and {Del Maestro}, Mattia and Andrea Morotti and Elbabaa, {Samer K.} and Anna Cavallini and Renato Galzio",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.wneu.2019.01.016",
language = "English",
journal = "World Neurosurgery",
issn = "1878-8750",
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T1 - Indication, Timing, and Surgical Treatment of Spontaneous Intracerebral Hemorrhage

T2 - Systematic Review and Proposal of a Management Algorithm

AU - Luzzi, Sabino

AU - Elia, Angela

AU - Del Maestro, Mattia

AU - Morotti, Andrea

AU - Elbabaa, Samer K.

AU - Cavallini, Anna

AU - Galzio, Renato

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: To delineate the most recommendable treatment of spontaneous intracerebral hemorrhages and the indication for surgery, its timing, and the best surgical technique to be adopted case by case. Methods: Based on PubMed/MEDLINE, Embase, and the Cochrane Library databases, a systematic review of the literature was performed using as keywords the terms “spontaneous intracerebral hemorrhage,” “surgical management,”, “medical management,” “supratentorial,”, and “infratentorial.” Because of the highest level of evidence, only randomized and nonrandomized clinical trials, meta-analyses, and comparative cohort studies reported within the last 12 years were selected. An updated and evidence-based treatment algorithm was reported also. Results: The search initially returned 255 articles. After application of the exclusion criteria, only 19 studies were selected. According to the site and volume of the hematoma, admission Glasgow Coma Scale (GCS) score, and progressive neurologic decline, specific subgroups were identified. Surgery must be considered in patients with an admission GCS score ranging between 5 and 12 and a hematoma volume >30 mL. The best time-window has been reported to be 7–24 hours after ictus. Endoscopic surgery is recommendable for patients with a supratentorial hematoma >60 mL and with a poor GCS score (4–8). Alternative techniques, such as minimally invasive puncture and thrombolysis, may be considered for deeper hematoma. Conclusions: Careful selection of patients eligible for surgery is mandatory. The optimal timing falls into a time-window ranging between 7 and 24 hours after ictus. Minimal invasive techniques are valuable surgical options for patients in a poor GCS score or harboring large deep-seated hemorrhages.

AB - Objective: To delineate the most recommendable treatment of spontaneous intracerebral hemorrhages and the indication for surgery, its timing, and the best surgical technique to be adopted case by case. Methods: Based on PubMed/MEDLINE, Embase, and the Cochrane Library databases, a systematic review of the literature was performed using as keywords the terms “spontaneous intracerebral hemorrhage,” “surgical management,”, “medical management,” “supratentorial,”, and “infratentorial.” Because of the highest level of evidence, only randomized and nonrandomized clinical trials, meta-analyses, and comparative cohort studies reported within the last 12 years were selected. An updated and evidence-based treatment algorithm was reported also. Results: The search initially returned 255 articles. After application of the exclusion criteria, only 19 studies were selected. According to the site and volume of the hematoma, admission Glasgow Coma Scale (GCS) score, and progressive neurologic decline, specific subgroups were identified. Surgery must be considered in patients with an admission GCS score ranging between 5 and 12 and a hematoma volume >30 mL. The best time-window has been reported to be 7–24 hours after ictus. Endoscopic surgery is recommendable for patients with a supratentorial hematoma >60 mL and with a poor GCS score (4–8). Alternative techniques, such as minimally invasive puncture and thrombolysis, may be considered for deeper hematoma. Conclusions: Careful selection of patients eligible for surgery is mandatory. The optimal timing falls into a time-window ranging between 7 and 24 hours after ictus. Minimal invasive techniques are valuable surgical options for patients in a poor GCS score or harboring large deep-seated hemorrhages.

KW - Hemorrhagic stroke

KW - Intracerebral hematoma

KW - Intracerebral hemorrhage

KW - Minimal invasive surgery

KW - Stroke management

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