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Clinical Treatment for Intracerebral Hemorrhage

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (25 February 2025) | Viewed by 7443

Special Issue Editor


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Guest Editor
1. Department of Neurosurgery, St. Luke Hospital, Thessaloniki, Greece
2. Medical School, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
Interests: cerebrovascular surgery; neurosurgery; intracranial bleeding; subarachnoid hemorrhage; microsurgery

Special Issue Information

Dear Colleagues,

The treatment of intracranial bleeding is as varied as its causes and depends on the medical discipline which encounters the patient first. Intracerebral hemorrhages can be caused by ruptured brain aneurysms, arteriovenous malformations, arteriovenous fistulas, amyloid angiopathies, or hypertensive bleeding. There is a dispute on the treatment of such bleeding between disciplines. For example, a ruptured intracranial aneurysm can lead to a coil embolization first and removal of the bleeding second or vice versa. For a cerebrovascular surgeon, the treatment is the removal of bleeding and clipping of the aneurysm in most cases. The treatment is not as obvious as it is for the cerebrovascular surgeon if a neurologist encounters such a patient first. The same applies for the treatment of ruptured arteriovenous malformations. These patients can stay in a neurology ward for a longer time and be treated with an embolization of the malformation after the bleeding has been resorbed. Even a Gamma knife treatment after blood resolution can be an option. Sometimes the treatment is as different as possible, as long it does not involve surgery. There is a trend to avoid surgery at any price, which is not based on evidence but personal opinion in non-neurosurgical disciplines. The need to reach a consensus about the treatment of such patients and to clarify which treatment is optimal is more important than ever since a conservative discipline like neurology can be the first to encounter the patient, or interventional radiology instead of neurosurgery. The treatments we offer to patients can be different, but the data regarding the morbidity and mortality of each option should be clear in order to be able to specify guidelines. No matter which discipline sees a patient first, it should always be clear that neurosurgery and interventional neurology both have to discuss the treatment options for every patient and ensure the treatment is based on hard evidence, not just a doctor’s feeling. We cannot afford to rely on personal opinions for our therapies. The actual data allow for a clear evidence-based approach, or at least they provide space for a scientific, unemotional conversation about the right treatment.

In this Special Issue, we hope to collect publications which will help physicians lead patients to the right treatment in intracerebral hemorrhages depending on pathology and other factors.

Prof. Dr. Athanasios K. Petridis
Guest Editor

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Keywords

  • intracerebral hemorrhage
  • intracerebral bleeding
  • ruptured intracranial aneurysm
  • arteriovenous malformation
  • arteriovenous fistulas

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Published Papers (3 papers)

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Review

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16 pages, 5320 KiB  
Review
Minimally Invasive Surgery for Spontaneous Intracerebral Hemorrhage: A Review
by Nourou Dine Adeniran Bankole, Cyrille Kuntz, Alexia Planty-Bonjour, Quentin Beaufort, Thomas Gaberel, Charlotte Cordonnier, Marco Pasi, Frieder Schlunk, Jawed Nawabi, Ilyess Zemmoura and Grégoire Boulouis
J. Clin. Med. 2025, 14(4), 1155; https://doi.org/10.3390/jcm14041155 - 11 Feb 2025
Cited by 2 | Viewed by 2918
Abstract
Background: Spontaneous intracerebral hemorrhage (ICH) accounts for approximately 20% of all strokes and is associated with high mortality and disability rates. Despite numerous trials, conventional surgical approaches have not demonstrated consistent improvements in functional outcomes. Minimally invasive surgery (MIS) for ICH evacuation [...] Read more.
Background: Spontaneous intracerebral hemorrhage (ICH) accounts for approximately 20% of all strokes and is associated with high mortality and disability rates. Despite numerous trials, conventional surgical approaches have not demonstrated consistent improvements in functional outcomes. Minimally invasive surgery (MIS) for ICH evacuation has emerged as a promising alternative, with the potential to improve functional outcomes and reduce mortality. Objectives: This narrative review aims to provide a comprehensive overview of various MIS techniques and their reported impact on functional outcomes in patients with spontaneous ICH while discussing key limitations in the existing literature. Methods: We systematically searched PubMed to identify studies published from 1 January 2010 to 22 March 2024. The search strategy included the following terms: (“minimally*”[All Fields] AND “invasive*”[All Fields] AND “surgery*”[All Fields] AND “intracerebral*”[All Fields] AND “hemorrhage*”[All Fields]) AND (2010:2024[pdat]). This review focuses on randomized controlled trials (RCTs) that evaluate MIS techniques for ICH and their clinical outcomes. Results: Our search identified six RCTs conducted between January 2010 and March 2024, encompassing 2180 patients with a mean age of 58.03 ± 4.5 years. Four trials demonstrated significantly improved functional recovery (mRs ≤ 3), reduced mortality, and fewer adverse events compared with standard medical management or conventional craniotomy. All MIS techniques rely on stereotactic planning and the use of tools such as exoscopes, endoscopes, craniopuncture, or thrombolytic irrigation for precise hematoma evacuation. These approaches reduce brain tissue disruption and improve precision. However, the variability in techniques, costs, and lack of an external validation limit the generalizability of these findings. Conclusions: MIS shows potential as an alternative to conventional management strategies for ICH, offering encouraging evidence for improved functional outcomes and reduced mortality in selected studies. However, these findings remain limited by gaps in the literature, including the need for external validation, significant methodological heterogeneity, and economic challenges. Further rigorous trials are essential to confirm the generalizability and long-term impact of these approaches. Full article
(This article belongs to the Special Issue Clinical Treatment for Intracerebral Hemorrhage)
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12 pages, 274 KiB  
Review
Probiotics in Traumatic Brain Injury: New Insights into Mechanisms and Future Perspectives
by Diamantoula Pagkou, Evangelos Kogias, Nikolaos Foroglou and Katerina Kotzampassi
J. Clin. Med. 2024, 13(15), 4546; https://doi.org/10.3390/jcm13154546 - 3 Aug 2024
Cited by 3 | Viewed by 1993
Abstract
Traumatic brain injury (TBI) is a serious global public health issue, recognized as a chronic and progressive disease that can affect multiple organs, including the gastrointestinal (GI) tract. Research shows that there is a specific link between the GI tract and the central [...] Read more.
Traumatic brain injury (TBI) is a serious global public health issue, recognized as a chronic and progressive disease that can affect multiple organs, including the gastrointestinal (GI) tract. Research shows that there is a specific link between the GI tract and the central nervous system, termed the gut–brain axis, which consists of bidirectional exchange between these two. Several preclinical and clinical studies have demonstrated intestinal barrier dysfunction, intestinal inflammation and gut dysbiosis in patients with TBI. It is proven that probiotics can modulate the inflammatory process and modify gut microbiota. Numerous animal studies and human clinical trials have proven the effectiveness of selected bacterial strains as an adjuvant treatment in reducing inflammation, infection rates and time spent in intensive care of hospitalized patients suffering from brain injury. Thus, this review summarizes the current evidence regarding the beneficial effects of probiotic administration in patients suffering from TBI-related complications. This review will help identify novel therapeutic strategies in the future as probiotics have an extensive history of apparently safe use. Full article
(This article belongs to the Special Issue Clinical Treatment for Intracerebral Hemorrhage)

Other

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9 pages, 541 KiB  
Systematic Review
Andexanet Alfa versus Four-Factor Prothrombin Complex Concentrate for the Reversal of Factor Xa (FXa) Inhibitor-Associated Intracranial Hemorrhage: A Systematic Review of Retrospective Studies
by Luan Oliveira Ferreira, Ricardo Andres León Oldemburg, João Monteiro Leitão Filho, Rodrigo Arcoverde Cerveira, Victoria Winkler Vasconcelos, Giovana Escribano da Costa, Roseny dos Reis Rodrigues and Dielly Catrina Favacho Lopes
J. Clin. Med. 2024, 13(11), 3077; https://doi.org/10.3390/jcm13113077 - 24 May 2024
Cited by 2 | Viewed by 1934
Abstract
Background/Objectives: There are limited data on the risks and benefits of using Andexanet alfa (AA) compared with four-factor prothrombin complex concentrate (4F-PCC) for the reversal of factor Xa inhibitor-associated intracranial hemorrhage (ICH). Our aim was to describe a compilation of the information [...] Read more.
Background/Objectives: There are limited data on the risks and benefits of using Andexanet alfa (AA) compared with four-factor prothrombin complex concentrate (4F-PCC) for the reversal of factor Xa inhibitor-associated intracranial hemorrhage (ICH). Our aim was to describe a compilation of the information available in the literature to date. Methods: PubMed, Embase, Web of Science (Clarivate Analytics) and the Cochrane Central Register of Controlled Trials were searched until December 2023. Following the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” guidelines, our systematic literature review included studies that were retrospective in design and evaluated both drugs to control bleeding and complications (death and thromboembolic events). Two researchers re-examined the studies for relevance, extracted the data and assessed the risk of bias. No meta-analyses were performed for the results. Results: In this limited patient sample, we found no differences between published articles in terms of neuroimaging stability or thrombotic events. However, some studies show significant differences in mortality, suggesting that one of the AAs may be superior to 4F-PCC. Conclusions: Our qualitative analysis shows that AA has a better efficacy profile compared with 4F-PCC. However, further studies monitoring these patients and a multicenter collaborative network dedicated to this topic are needed. Full article
(This article belongs to the Special Issue Clinical Treatment for Intracerebral Hemorrhage)
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