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Bendok, Bernard R. et al.: 2025 Hemorrhagic and Ischemic Stroke DOI: 10.1055/b-0044-205930
Section III Open Surgical, Minimally Invasive and Microsurgical Approaches

29 Minimally Invasive Approaches for Intracerebral Hemorrhage and Intraventricular Hemorrhage

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Editors: Bendok, Bernard R.; Batjer, H. Hunt

Authors: Abi-Aad, Karl; Abuelem, Tarek; Açiş, Onur; Agnoletto, Guilherme J.; El Ahmadieh, Tarek; Albuquerque, Felipe C.; Amenta, Peter S.; Amoss, James; Aoun, Salah G.; Arthur, Adam S.; Awad, Issam A.; Ban, Vin Shen; Barrow, Daniel L.; Bebawy, John F.; Biller, José; Binning, Mandy J.; Blech, Benzion; Bonney, Phillip A.; Brasiliense, Leonardo B.C.; Carlin, Rachel E.; Carrión-Penagos, Julián; Chong, Brian W.; Christel, Lynda M.; Church, Ephraim W.; Connolly, E. Sander; Connor, Michelle; Dalfino, John C.; Demaerschalk, Bart M.; Dumitrascu, Oana M.; Entezami, Pouya; Felbaum, Daniel; Freeman, W. David; Garcia, Jose Omar; Goyal, Nitin; Granja, Manuel F.; Hanel, Ricardo A.; Heiferman, Daniel M.; Hemphill, J. Claude; Hess, Ryan; Howard, Brian M.; Hudson, Miles; Ingall, Timothy J.; Inoa, Violiza; Jabbour, Pascal M.; Jacob, Sneha; Johnson, Mark D.; Kalen, Brian; Kicielinski, Kimberly P.; Koester, Stefan W.; Koht, Antoun; Kondziolka, Douglas; Krishna, Chandan; Kronenburg, Annick; Kumar, Gyanendra; Langer, David; Levy, Elad I.; Mack, William J.; Merrill, Sarah; Meyer, Fredric B.; Monteiro, André; Montaño, Arturo; El Naamani, Kareem; Nossek, Erez; O’Carroll, Cumara B.; Ogilvy, Christopher S.; Ogunsola, Oludotun; Ottenhoff, Lauren; Oushy, Soliman; Patel, Bhavesh; Patra, Devi P.; Peacock, Sarah; Pena, Austin; Pines, Andrew; Polster, Sean P.; Rahme, Rudy J.; Rebeiz, Tania; Riina, Howard; Rinaldo, Lorenzo; Sattur, Mithun G.; Sen, Ayan; Siegel, Jason; Sim, Justin L.; Simon, Scott D.; Solomon, Robert A.; Spetzler, Robert; Sweid, Ahmad; Syal, Arjun; Tomlinson, Amanda; Turcotte, Evelyn L.; Turkmani, Ali H.; Vakharia, Kunal; Vanderhye, Vanesa K.; Veznedaroglu, Erol; Walia, Parampreet Singh; Waqas, Muhammad; Welch, Babu G.; Welz, Matthew E.; White, Jonathan A.; Winter, JoDee; Zaatar, Muriel T.; Zeeni, Carine

Title: Hemorrhagic and Ischemic Stroke

Subtitle: Medical, Imaging, Surgical, and Interventional Approaches

Print ISBN: 9781684200436; Online ISBN: 9781684203819; Book DOI: 10.1055/b000000291

2. Edition © 2025. Thieme. All rights reserved.
Thieme Medical Publishers, Inc., New York

Subjects: Neurosurgery

Thieme Clinical Collections (English Language)



 
Sean P. Polster, Julián Carrión-Penagos, and Issam A. Awad

Abstract

Intracerebral hemorrhage (ICH), including intraventricular hemorrhage (IVH), is a worldwide problem without solid strategies for treatment or prevention. Ten percent to 15% of all strokes are hemorrhagic in nature representing the highest mortality rates and substantial morbidity rates of all strokes. Clinical management of ICH/IVH varies significantly and lacks a consensus-based standard of care. The Minimally Invasive Surgery with Thrombolysis in ICH Evacuation (MISTIE) and Clot Lysis Evaluation of Accelerated Resolution (CLEAR) trials represent the latest robust clinical trial evidence on minimally invasive treatment aimed at improving outcomes. In this chapter, we discuss the pathogenesis and outcome determinants, acute resuscitation and medical management, and historical open trials to better frame advances in management strategies to prevent hematoma enlargement and ultimately strategies to evacuate hematomas. New techniques and approaches are currently being investigated for safety and efficacy which we present with lessons learned along with future directions on minimally invasive management of ICH and IVH. Ongoing investigations have a high potential to change clinical practice by optimizing case selection and the surgical task with an aim of improving outcomes. Future well-designed, pragmatic clinical trials will be required to integrate the key lessons learned to finally make an impact in this devastating disease.

Key words

minimally invasive surgery - intracerebral hemorrhage - intraventricular hemorrhage - clot evacuation - Minimally Invasive Surgery and Thrombolytic Evacuation in ICH Evacuation - Clot Lysis Evaluation of Accelerated Resolution
 
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