Advancing Medical and Surgical Options for Intracranial Hemorrhage (Podcast)

Outcomes for patients with intracranial hemorrhage (ICH) can be improved by skilled surgical and intensive care, but few recent advancements have been made to move the needle on these patients’ prognosis.

“Prevention is key for this disease,” says Joao Gomes, MD, a vascular neurologist and neurocritical care specialist at Cleveland Clinic. “However, even if you control blood pressure in the population at large, you’re still going to have patients who for one reason or another will experience intracranial hemorrhage. So we still need to find effective therapies.”

In the latest episode of Cleveland Clinic’s Neuro Pathways podcast, Dr. Gomes joins Mark Bain, MD, Head of Cerebrovascular and Endovascular Neurosurgery at Cleveland Clinic, to examine the future of ICH diagnosis and treatment. They discuss:

• Progress in medical and surgical management of patients with ICH
• How to identify people at risk
• Development of smaller surgical devices with better hemorrhage evacuation rates
• Drawing from the field of ischemic stroke to guide advancements in ICH
• Seminal and ongoing trials in the field of ICH

Click the podcast player above to listen to the episode now, or read on for an edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

Excerpt from the episode

Dr. Bain: As a field, intracerebral hemorrhage is sort of where stroke was in 2013. We don’t necessarily understand the proper patients to operate on. We’re still honing our techniques surgically, and we don’t truly understand what the inflammatory cascade is around these hematomas and how we can help patients by stopping inflammation. So I think the next five to 10 years in this space are going to be absolutely fascinating.

We’re working on better devices. We can even do this through endoscopic approaches where we can make small burr holes, placing these little tubes about as big as a straw down into the hemorrhage, and remove the hemorrhage with minimal collateral damage to the surrounding brain. So the hope there is that you can stop pressure on the surrounding neurons and the surrounding white matter tracts. By getting the hematoma out, we can reduce the edema and the swelling reaction that happens and the secondary injury.

And we have even done research looking at spot signs. These are active extravasations of contrast on CAT scans that suggest there is active bleeding happening. And we know very well that if we leave those alone, those hemorrhages will continue to expand and the patient outcome will most likely be fatal. So we have actively targeted those spot signs with our devices and found bleeding vessels that we can coagulate and stop the hematoma from expanding.

These are all therapeutic windows where we can potentially interact. The challenge now is to hone these skills and make them standard across practitioners so we can study them. And then we need well-designed randomized trials to prove that this is working.