Minimally Invasive Surgery vs Medical Management Alone for Intracerebral Hemorrhage: The MIND Randomized Clinical...

Area of Science:

• Neurosurgery
• Neurology
• Clinical Trials

Background:

• Supratentorial intracerebral hemorrhage (ICH) poses significant risks, with functional outcomes often remaining uncertain.
• The efficacy of surgical evacuation versus conservative medical management for ICH is a critical clinical question.
• Minimally invasive surgery (MIS) techniques have emerged as potential alternatives for ICH treatment.

Purpose of the Study:

• To compare the safety and efficacy of MIS using the Artemis Neuro Evacuation Device against guideline-based medical management for spontaneous supratentorial ICH.
• To evaluate the impact of MIS on functional outcomes and mortality in patients with supratentorial ICH.

Main Methods:

• The MIND trial was an open-label, multicenter randomized clinical trial comparing MIS plus medical management to medical management alone.
• Adult patients (18-80 years) with moderate- to large-volume supratentorial ICH (20-80 mL) were randomized (2:1 ratio).
• Primary outcomes included 180-day combined death and disability (modified Rankin Scale) and 30-day mortality.

Main Results:

• Enrollment was stopped early at 236 participants following an independent feasibility analysis.
• MIS did not demonstrate superiority over medical management in reducing 180-day combined death and disability (OR, 1.03; P=.45).
• 30-day mortality rates were similar between the MIS group (7.2%) and the medical management group (9.8%).

Conclusions:

• In the MIND trial, minimally invasive surgery within 72 hours of symptom onset did not significantly improve outcomes for supratentorial ICH.
• These findings suggest that MIS with the Artemis device is not superior to medical management alone for this patient population.
• Further research may be needed to identify specific subgroups of ICH patients who could benefit from surgical intervention.