Minimally Invasive Surgery for Patients with Spontaneous Intracerebral Hemorrhage: a Book Reopened

In contrast to remarkable recent gains made in the outcomes of patients with ischemic stroke, outcomes for patients with hemorrhagic stroke (spontaneous intracerebral hemorrhage [ICH]) remain poor. The results of past surgical trials for ICH—motivated by the hypothesis that patients would benefit from interventions to reduce intracranial hypertension associated with clot burden and prevent secondary injury induced by blood in the brain parenchyma—have to date been disappointing. Here, we review the results of the recently completed Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation III trial, which suggest that minimally invasive ICH evacuation may be clinically beneficial, but only when significant hematoma evacuation is achieved, and discuss ongoing minimally invasive surgical evacuation trials for ICH.