Neurosurgery trial: Early evacuation improves long-term hemorrhage outcomes

Editor's Note

Medical management care with evacuation surgery could yield better 180-day outcomes than without in patents treated within 24 hours for acute intracerebral hemorrhage, according to study results covered in an April 10 MedPage Today report.

The ENRICH (Early MiNimally-invasive Removal of IntraCerebral Hemorrhage (ICH)) trial is a multicenter, randomized, adaptive clinical trial comparing standard medical management to early (<24 hours) surgical hematoma evacuation using minimally invasive parafascicular surgery (MIPS) in the treatment of acute spontaneous supratentorial intracerebral hemorrhage.

Citing ENRICH trial data published April 10 in the New England Journal of Medicine, MedPage reports that more patients in the control group not only survived, but showed improvement based on mean utility-weighted modified Rankin score (mRS) range (on a scale of 0 to 1, mean mRS was 0.458 in the surgery group compared with 0.374 in the control group at 180 days).  Researchers attribute the result to intervention for lobar supratentorial hemorrhages.

According to the report, which offers a detailed examination of the data and the context for the trial, current guidelines support surgery for spontaneous intracerebral hemorrhage only as a last resort in most cases.