@article{JNI13093,
author = {Samuel Masresha Fetene and Wondwossen G. Tekle and Samantha Miller and Mikael Aseged and Ameer E. Hassan},
title = {Intracerebral hemorrhage evacuation with minimally invasive surgery by neurointerventionalists: a review},
journal = {Journal of Neurointervention},
volume = {2},
number = {0},
year = {2026},
keywords = {},
abstract = {Spontaneous intracerebral hemorrhage (ICH) has a high mortality & morbidity, and is primarily caused by hypertension, particularly in lower- and middle-income countries where there is a high prevalence of uncontrolled hypertension, limited health care facilities and limited trained personnel. So far, randomized trials have not shown a reproducible benefit from conventional open surgery by craniotomy. The advent of minimally invasive surgery (MIS) for hematoma evacuation has reignited efforts to prove improved ICH outcomes. With the lack of clear guidelines on the use of MIS, a variety of management protocols exist across institutions. We aim to present a review of recent advances in MIS for ICH and propose an alternative pathway for ICH management in comprehensive stroke centers. The alternative pathway for ICH management emphasizes early identification and activation of a dedicated “code ICH”, paralleling existing stroke emergency systems. It highlights the critical role of neurointerventionists in performing image-guided hematoma evacuation, the need for specialized physician training, and the establishment of coordinated hospital processes to enable rapid triage, imaging, and intervention. By integrating the proposed “Emergency Pathway for Intracerebral Hemorrhage” within the established “Stroke Emergency Pathway”, comprehensive stroke centers can leverage existing infrastructure, streamline multidisciplinary collaboration, and optimize outcomes. Implementation of this approach, supported by high-quality evidence and updated clinical guidelines, could enhance access to effective MIS interventions, particularly in resource-limited settings. As high-class evidence of the benefit of MIS accumulates and if new guideline recommendations for early ICH evacuation to improve functional outcomes are adopted, timely intervention by an expanded and experienced workforce may be required. The increased demand may be unmet otherwise, particularly in lower- and middle-income countries. Existing comprehensive stroke centers providing streamlined “code-strokes” are ideally placed to manage this new “code ICH”. Tapping into the existing neuroendovascular workforce to rapidly increase patient access to care is feasible and should be considered.},
issn = {3104-8943}, url = {https://jni.amegroups.org/article/view/13093}
}