Spontaneous intracerebral and intraventricular hemorrhage: advances in minimally invasive surgery and thrombolytic evacuation, and lessons learned in recent trials.
Spontaneous intracerebral and intraventricular hemorrhage: advances in minimally invasive surgery and thrombolytic evacuation, and lessons learned in recent trials.
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DOI：
10.1227/neu.0000000000000221
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发表时间：
2014-03
期刊：
影响因子：
4.8
通讯作者：
Awad IA
中科院分区：
文献类型：
--
作者：
Dey M;Stadnik A;Awad IA
自发性脑出血（ICH）的最佳治疗仍然是神经外科领域中备受争议的领域之一。早期的研究比较开放手术干预与最佳医疗管理未能显示出明显的好处。最新的微创技术经验显示出更大的希望。设计良好的II期试验已证实了溶栓抽吸和清除自发性ICH及相关脑室内梗阻性出血的安全性和初步治疗效果。这些试验进行了审查，包括各自的协议和技术的细微差别，以及经验教训，病人的选择，出血稳定的概念，优化手术程序，溶栓剂量的决定。这些概念已被纳入由美国国立卫生研究院资助的正在进行的明确的III期随机试验（MISTIE和CLEAR）的设计中。这些都提出了包括手术领导的作用，在培训和监测的手术任务和质量保证。这些技术对神经外科实践的影响进行了讨论。
Optimal management of spontaneous intracerebral hemorrhage (ICH) remains one of the highly debated areas in the field of neurosurgery. Earlier studies comparing open surgical intervention with best medical management failed to show a clear benefit. More recent experience with minimally invasive techniques has shown greater promise. Well-designed phase II trials have confirmed the safety and preliminary treatment effect of thrombolytic aspiration and clearance of spontaneous ICH and associated intraventricular obstructive hemorrhage. Those trials are reviewed, including respective protocols and technical nuances, and lessons learned regarding patient selection, the concept of hemorrhage stabilization, optimization of the surgical procedure, and thrombolytic dosing decisions. These concepts have been incorporated in the design of ongoing definite phase III randomized trials (MISTIE and CLEAR) funded by the National Institutes of Health. These are presented including the role of surgical leadership in the training and monitoring of the surgical task and quality assurance. The impact of these techniques on neurosurgical practice is discussed.