In this video, MUSC Health neurosurgeon Alejandro M. Spiotta, M.D. discusses three minimally invasive surgical (MIS) techniques for evacuation of hematoma in patients who experience intracerebral hemorrhage (ICH): a combination of MIS and clot lysis using tissue plasminogen activator (MISTIE II trial), an endoscopically guided suction device (Apollo; Penumbra, INVEST trial) and parafascicular surgery using the NICO Brain Path sheath (ENRICH trial). A definitive answer as to which of these three techniques achieves the best outcomes in these patients awaits the results of the MISTIE III, INVEST and ENRICH trials, but optimism is growing that hematoma reduction using MIS techniques could begin to reduce ICH-related mortality and disability. MUSC Health offers all three MIS options for hematoma evacuation.
ICH is the most deadly and debilitating form of stroke. Reducing hematoma volume after ICH could help improve survival and reduce disability. However, trauma to brain tissue caused by open surgical approaches outweigh any of the benefit over medical management gained by hematoma reduction. As a result, most patients with ICH are medically managed, but as many as half die from the disease and most become too disabled to live independently. MIS techniques for hematoma evacuation were developed to improve the odds for these patients and, if proven effective, could swing the balance from medical management toward surgical intervention.