Neuroanesthesia & neurocritical care
Surgery for intracerebral hemorrhage: new evidence and changing perspectives
Authors' conclusion
Together, the ENRICH and SWITCH trials collectively challenge decades of therapeutic pessimism in ICH, signaling a shift toward selective, mechanistically informed surgical intervention in ICH, one emphasizing minimally invasive access for lobar bleeds and decompression for malignant deep hemorrhages.
Study context
- Population
- Patients with spontaneous intracerebral hemorrhage (ICH)3 RCTs (ENRICH, MIND, SWITCH)
- Comparison
- Surgical approaches vs medical management for ICH
- Outcome
- Functional outcome and mortality in the three RCTs
Main finding
As reported in the abstract
- ENRICH (early minimally invasive parafascicular surgery (MIPS), lobar and anterior basal ganglia ICH): superior functional outcomes at 180 days, particularly in lobar ICH, with lower mortality
- MIND (catheter-based aspiration, deep supratentorial ICH): substantial clot reduction but no statistically significant improvement in functional independence at 180 days
- SWITCH (decompressive craniectomy without evacuation, large deep ICH; underpowered, premature termination): possible reduction in mortality and trend toward fewer patients with severe disability or death at 6 months
Safety
Safety of surgical intervention
- ENRICH: safety comparable to medical therapy
- MIND: procedural feasibility and safety demonstrated
- SWITCH: no excess adverse events
Original publication
Surgery for intracerebral hemorrhage: new evidence and changing perspectives. Crit Care. Published 1 December 2025. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →