Minor invasive haematoma removal improved haemorrhagic stroke outcomes

American researchers conducted multicentre randomised trials and concluded that minimally invasive surgical removal of lobar haematoma in the first day of haemorrhagic stroke improves the prognosis of patients compared to conservative treatment. The publication appeared in The New England Journal of Medicine. Gustavo Pradilla (Gustavo Pradilla) from Emory University and colleagues included in the ENRICH trial 300 patients with acute intracranial haemorrhage of 30 to 80 millilitres (in 69.3 percent of them it was localised in the lobes of the brain; in 30.7 percent - in the anterior basal nuclei). Half of them underwent surgical removal of the haematoma (small craniodurotomy and vacuum extraction through the gyrus) within 24 hours of symptom onset, in addition to standard drug therapy; the rest were treated with medication alone. The primary efficacy endpoint was a weighted modified Rankin scale score (0 to 1, the higher the better the condition) at day 180, and safety was death in the first 30 days.

It was found that for cerebral lobe haemorrhages, surgery resulted in a mean score increase of 0.127 by day 180; for basal nucleus haemorrhages, there was no similar improvement. In the first 30 days, 9.3 per cent of participants in the main group died compared with 18 per cent in the control group. However, 3.3 per cent of patients developed rebleeding and worsened neurological symptoms after surgery.