(Part 19) Trial of Early Minimally Invasive Removal of Intracerebral Hemorrhage скачать в хорошем качестве

(Part 19) Trial of Early Minimally Invasive Removal of Intracerebral Hemorrhage

🧠 The ICH surgery breakthrough that rewrote the textbooks 🧠 For 30 years, surgery for intracerebral hemorrhage was considered futile. Then the ENRICH trial changed everything, proving that timing and technique matter more than we ever imagined. The 30-Year Problem: Multiple large trials (STICH, STITCH II, MISTIE-III) consistently showed that surgical evacuation of ICH provided no functional benefit over medical management. Neurosurgeons had nearly given up on operating for spontaneous brain hemorrhages. What They Did: ✅ 300 patients with lobar or anterior basal ganglia ICH (30-80ml volume) ✅ Randomized within 24 hours of symptom onset ✅ Minimally invasive trans-sulcal parafascicular surgery (MIPS) vs medical management ✅ Primary outcome: utility-weighted modified Rankin Scale at 180 days ✅ 37 US hospitals, 2017-2023 (paused for COVID) Game-Changing Results: 🎯 Significantly better functional outcomes with early surgery (p less than 0.001) 🎯 Mean uwmRS score: 0.458 vs 0.374 (surgery vs medical management) 🎯 Effect driven primarily by lobar hemorrhages - the superficial ones 🎯 No significant increase in complications vs medical management 🎯 First positive ICH surgery trial in modern neurosurgical history Why This Worked When Others Failed: 💡 Ultra-early intervention (within 24 hours, ideally less than 8 hours) 💡 Minimally invasive approach - trans-sulcal access spares white matter 💡 Selective patient population - lobar/anterior basal ganglia only 💡 Standardized surgical technique with mandatory training 💡 Focus on superficial hemorrhages where surgery benefits most Clinical Impact: This trial has fundamentally changed neurosurgical practice. We now have Level 1 evidence that early, minimally invasive evacuation can improve functional outcomes in selected ICH patients. The key is patient selection and timing - not all hemorrhages, but the right ones, operated on quickly with the right technique. How has this changed your practice? Are you seeing more early ICH consultations in your hospital? 🤔 👆 Follow for more game-changing trials | Share with your neurosurg/stroke team | Visit NowyouknowNeuro.com for the complete breakdown #Neurology #IntracerebraHemorrhage #ENRICH #MinimallyInvasiveSurgery #Neurosurgery #Stroke #ICH #StrokeNeurology #EvidenceBasedMedicine #NeurocriticalCare [Links] Original Article: https://www.nejm.org/doi/full/10.1056... NowYouKnow Neuro: https://www.nowyouknowneuro.com/ Subscribe: https://www.nowyouknowneuro.com/sign-... Instagram: NowyouknowNeuro