Intracerebral Hemorrhage: A Common and Devastating Disease in Need of Better Treatment.

OBJECTIVE: To review the poor natural history of intracerebral hemorrhage (ICH), current treatment options for ICH, discuss ongoing trials evaluating minimally invasive techniques for clot evacuation, and offer future directions of investigation for the management of this devastating disease. METHODS: A selective review of recent trials regarding treatment of ICH was performed. RESULTS: Completed trials of medical and surgical management are reviewed. The supportive research for clot evacuation to limit secondary injury is surveyed. We also provide a comprehensive discussion of current data evaluating minimally invasive techniques to achieve clot removal, including Minimally Invasive Surgery plus tPA for ICH Evacuation (MISTIE), Clot Lysis: Evaluating Accelerated Resolution (CLEAR), and endoscopic evacuation. CONCLUSION: We encourage the neurosurgical community to pursue improved therapies for ICH. PRACTICE: New minimally invasive treatments for ICH are being developed. IMPLICATIONS: Treatment of ICH is an important area of research and should continue to be aggressively pursued because of the significant societal burden and poor outcomes associated with ICH.