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Updated: Aug 6, 2025
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Intracerebral haemorrhage
Laurent Puy1, Adrian R Parry-Jones2,3,4, Else Charlotte Sandset5,6
1Lille Neuroscience & Cognition (LilNCog) - U1172, University of Lille, Inserm, CHU Lille, Lille, France.
Insights
Intracerebral haemorrhage (ICH) is a severe brain bleed impacting survival and quality of life. While understanding and prediction have improved, preventing hematoma expansion remains the critical, albeit challenging, therapeutic target.
Area of Science:
- Neurology
- Vascular Medicine
- Critical Care Medicine
Background:
- Intracerebral haemorrhage (ICH) results from cerebral vessel rupture, leading to blood entering brain tissue.
- ICH significantly contributes to stroke-related mortality and long-term patient dependency, with only 50% survival at one year.
- Increasing ICH incidence is linked to improved vascular prevention and increased antithrombotic agent use.
Purpose of the Study:
- To review the current understanding of intracerebral haemorrhage (ICH).
- To discuss the pathophysiology, incidence trends, and outcomes associated with ICH.
- To highlight the challenges in ICH management and secondary prevention.
Main Methods:
- Review of existing literature on intracerebral haemorrhage.
- Analysis of pathophysiology, including mass effect, hematoma expansion, and secondary injury.
- Examination of trends in ICH incidence and outcomes over recent decades.
Main Results:
- ICH pathophysiology involves complex mechanical and secondary injury processes.
- Hematoma expansion is identified as the primary therapeutic target in acute ICH.
- Advances in identifying causes and predicting outcomes have been made, but specific treatments remain elusive.
Conclusions:
- Intracerebral haemorrhage (ICH) is a critical medical emergency requiring immediate attention.
- Prevention of hematoma expansion is the key focus for acute ICH management.
- Long-term management of vascular risk factors post-ICH presents ongoing challenges, necessitating individualized risk-benefit assessments.
Abstract:
Intracerebral haemorrhage (ICH) is a dramatic condition caused by the rupture of a cerebral vessel and the entry of blood into the brain parenchyma. ICH is a major contributor to stroke-related mortality and dependency: only half of patients survive for 1 year after ICH, and patients who survive have sequelae that affect their quality of life. The incidence of ICH has increased in the past few decades with shifts in the underlying vessel disease over time as vascular prevention has improved and use of antithrombotic agents has increased. The pathophysiology of ICH is complex and encompasses mechanical mass effect, haematoma expansion and secondary injury. Identifying the causes of ICH and predicting the vital and functional outcome of patients and their long-term vascular risk have improved in the past decade; however, no specific treatment is available for ICH. ICH remains a medical emergency, with prevention of haematoma expansion as the key therapeutic target. After discharge, secondary prevention and management of vascular risk factors in patients remains challenging and is based on an individual benefit-risk balance evaluation.
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