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Manejo quirúrgico de la hemorragia intraparenquimatosa primaria supratentorial.
Resumen
Introducción: La enfermedad cerebrovascular supone una de las primeras causas de mortalidad y discapacidad en el mundo. El objetivo a perseguir en el tratamiento quirúrgico es la máxima evacuación del hematoma minimizando el daño del tejido sano. En la actualidad no existe un criterio unánime para el manejo quirúrgico de la hemorragia intraparenquimatosa primaria lo que nos motivó a la realización de este trabajo con el objetivo de realizar una revisión bibliográfica actualizada en el tema, que logre exponer los diferentes criterios para el manejo quirúrgico y describir los mejores resultados.
Desarrollo: Las indicaciones actuales para la evacuación quirúrgica incluyen: deterioro neurológico progresivo, expansión importante del hematoma, presión intracraneal incontrolable o datos de herniación cerebral. Para realizar un adecuado tratamiento quirúrgico es imprescindible conocer su fisiopatología para poder lograr los objetivos quirúrgicos y mejorar la morbimortalidad. Aunque actualmente se mantiene en controversia el tiempo ideal para realizar la evacuación de la hemorragia cerebral estudios aleatorizados han determinado un rango de tiempo entre 4 a 96 horas desde el comienzo de los síntomas con buenos resultados. Estudios actuales han demostrado buenos resultados en el manejo en etapas tempranas y bajo apoyo endoscópico.
Conclusiones: El manejo quirúrgico de la hemorragia intracerebral primaria se mantiene controversial. La escala de la hemorragia intraparenquimatosa es confiable para determinar pronóstico de los pacientes. Nuevos estudios aleatorizados se deben desarrollar para determinar cuál será la terapéutica ideal con el fin de mejorar la calidad de vida una vez presentada la hemorragia.
Palabras clave
Referencias
Hamad F, Kretschmer T, Morcos JJ. Nonlesional Spontaneous Intracerebral Hemorrhage. En: Alterman Rl, Brem H, Bullocks R, Burchiel KJ, Chiocca A, Connolly ES, et al. Youmans Neurological Surgery. Part 3, Chapter 358. Philadelphia: Elsevier; 2011.p. 3706-35.
Kreitzer N, Adeoye O. An Update on Surgical and Medical Management Strategies for Intracerebral Hemorrhage. Semin Neurol [Internet]. 2013 [citado 12 Sep 2015]; 33(5): 462-7. Disponible en: http://europepmc.org/abstract/med/24504609.
Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet [Internet]. 2013 [citado 12 Sep 2016]; 382: 397–408. Disponible en: doi: 10.1016/S0140-6736(13)60986-1.
Auer LM, Deinsberger W, Niederkorn K, Gell G, Kleinert R, Schneider G, et al. Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study. J Neurosurg. 1989 Apr; 70(4): 530-5.
Bakshi A, Bakshi A, Banerji AK. Neuroendoscope-assisted evacuation of large intracerebral hematomas: introduction of a new, minimally invasive technique. Preliminary report. Neurosurg Focus [Internet]. 2004 Jun 15 [citado 12 Sep 2016]; 16(6): 9. Disponible en: http://thejns.org/doi/abs/10.3171/foc.2004.16.6.8.
Manno ME. Update on Intracerebral Hemorrhage. Critical Care Neurology [Internet]. 2012 Jun [citado 12 Sep 2015]; 18(3): 598–610. Disponible en: http://journals.lww.com/continuum/Abstract/2012/06000/Update_on_Intracerebral_Hemorrhage.11.aspx.
Cuba, Ministerio de Salud Pública. Anuario Nacional de Estadísticas [Internet]. La Habana: Editorial; 2014 [citado 29 Nov 2015]. Disponible en: http://www.infomed.sld.cu/servicios/estadisticas/.
Aguilar MI, BrottThG. Update in Intracerebral Hemorrhage. Neurohospitalist [Internet]. 2011 Jul [citado 12 Ene 2015]; 1(3): 148–59. Disponible en: http://nho.sagepub.com/content/1/3/148.short.
Awad AJ, Walcott BP, Stapleton ChJ, Yanamadala V, Nahed BV, Coumans JV. Dabigatran, intracranial hemorrhage, and the neurosurgeon. Neurosurgical Focus [Internet]. 2013 May [citado 12 Ene 2015]; 34(5): 7. Disponible en: http://thejns.org/doi/abs/10.3171/2013.2.FOCUS1323.
Takeuchi S, Wada K, Nagatani K, Otani N, Mori K. Decompressive hemicraniectomy for spontaneous intracerebral hemorrhage.Neurosurgical Focus [Internet]. 2013 May [citado 12 Ene 2015]; 34(5): 5. Disponible en: http://thejns.org/doi/abs/10.3171/2013.2.FOCUS12424.
Simon G, Heuts BS, Bruce SS, Brad E, Zacharia MA, HickmanZL, et al. Decompressive hemicraniectomy without clot evacuation in dominant-sided intracerebral hemorrhage with ICP crisis. Neurosurgical Focus [Internet]. 2013 May [citado 12 Ene 2015]; 34(5): 4. Disponible en: http://thejns.org/doi/abs/10.3171/2013.2.FOCUS1326.
BelurPK, ChangJJ, HeBS Sh, Benjamin AE, MackWJ. Emerging experimental therapies for intracerebral hemorrhage: targeting mechanisms of secondary brain injury. Neurosurgical Focus [Internet]. 2013 May [citado 12 Ene 2015]; 34(5): 9. Disponible en: http://thejns.org/doi/abs/10.3171/2013.2.FOCUS1317.
Kreitzer N, Opeolu Adeoye MS. An Update on Surgical and Medical Management Strategies for Intracerebral Hemorrhage. SeminNeurol [Internet]. 2013 [citado 12 Sep 2015]; 33(5): 462-7. Disponible en: http://europepmc.org/abstract/med/24504609.
MISTIE Phase II results: Safety, efficacy, and surgical performance [Internet]. Google [citado 12 Sep 2015]. Disponible en: http://my.americanheart.org/professional/Sessions/Interna-tional Conference/ScienceNews/ISC-2012-Late-Breaking-Science-Oral-abstract_UCM_435384_Article.jsp.
Dye JA, Dusick JR, Lee DJ, Gonzalez NR, Martin NA. Frontal bur hole through an eyebrow incision for image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage. J Neurosurg [Internet]. 2012 [citado 12 sep 2015]; 117: 767–73.
Steiner T, Vincent C, Morris S, Davis S, Vallejo-Torres L, Christensen MC. Neurosurgical outcomes after intracerebral hemorrhage: results of the Factor Seven for Acute Hemorrhagic Stroke Trial (FAST). J Stroke Cerebrovasc Dis [Internet]. 2011 [citado 12 Sep 2015]; 20: 287–94. Disponible en: http://www.sciencedirect.com/science/article/pii/S1052305710000340.
Asch CJ, Luitse MJ, Rinkel GJ, Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol [Internet]. 2010 [citado 12 Sep 2015]; 9: 167–76. Disponible en: http://www.sciencedirect.com/science/article/pii/S1474442209703400.
Kleindorfer DO, Khoury J, Moomaw CJ. Stroke incidence is decreasing in whites but not in blacks: a population-based estimate of temporal trends in stroke incidence from the Greater Cincinnati/Northern Kentucky Stroke Study. Stroke [Internet]. 2010 [citado 14 Oct 2015]; 41: 1326–31. Disponible en: http://stroke.ahajournals.org/content/41/7/1326.short.
Hansen F, González JH. Revisión de escalas de pronósticopara el Accidente Cerebrovascular agudo hemorrágico. Review of prognostic scales for acute Intracerebral Hemorrhage. Revista Memoriza [Internet]. 2010 [citado 12 Sep 2016]; 7: 32-41. Disponible en: http://www.neurologia.com/pdf/Web/5312/bg120705.pdf.
Staykov D, Wagner I, Volbers B. Natural course of perihemorrhagic edema after intracerebral hemorrhage. Stroke [Internet]. 2011 [citado 14 Oct 2015]; 42: 2625–29. Disponible en: http://stroke.ahajournals.org/content/42/9/2625.short.
Dowlatshahi D, Smith EE, Flaherty ML. Small intracerebral haemorrhages are associated with less haematoma expansion and better outcomes. Int J Stroke [Internet]. 2011 [citado 14 Oct 2015]; 6: 201–6. Disponible en: http://onlinelibrary.wiley.com/doi/10.1111/j.1747-4949.2010.00563.x/full.
Qureshi AI. Intracerebral hemorrhage specific intensity of care quality metrics. Neurocrit Care [Internet]. 2011 [citado 14 Oct 2015]; 14: 291–31. Disponible en: http://link.springer.com/article/10.1007/s12028-010-9453-z.
Morgenstern LB, Hemphill JC, Anderson C. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke [Internet]. 2010 [citado 17 Oct 2015]; 41: 2108–29. Disponible en: http://circ.ahajournals.org/content/115/20/e478.short.
Sheth KN, Gilson AJ, Chang Y. Packed red blood cell transfusion and decreased mortality in intracerebral hemorrhage. Neurosurgery [Internet]. 2011 [citado 16 Oct 2015]; 68: 1286–92. Disponible en: http://journals.lww.com/neurosurgery/Abstract/2011/05000/Packed_Red_Blood_Cell_Transfusion_and_Decreased.15.aspx.
Hemphill JC, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke [Internet]. 2001 [citado 17 Oct 2015]; 32: 891–7. Disponible en: http://stroke.ahajournals.org/content/32/4/891.short.
Mendelow AD, Gregson BA, Fernandes HM, Murray GD.
Teasdale GM, Hope DT. Early surgery versus initial
conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical
Trial in Intracerebral Haemorrhage (STICH): a randomised
trial. Lancet [Internet]. 2005 [citado 16 Oct 2015]; 365: 387–97. Disponible en: http://www.sciencedirect.com/science/article/pii/S0140673613609861.
Dowlatshahi D, Demchuk AM, Flaherty ML, Ali M, Lyden PL, Smith EE. Defining hematoma expansion in intracerebral hemorrhage: relationship with patient outcomes. Neurology [Internet]. 2011 [citado 15 Oct 2015]; 76(14): 1238–44. Disponible en: http://www.neurology.org/content/76/14/1238.short.
Delcourt C, Huang Y, Arima H. Hematoma growth and outcomes in intracerebral hemorrhage: the INTERACT1 study. Neurology [Internet]. 2012 [citado 15 Oct 2015]; 79(4): 314–9. Disponible en: http://www.neurology.org/content/79/4/314.short.
Adeoye O, Broderick JP. Advances in the management of intracerebral hemorrhage. Nature reviews Neurology [Internet]. 2010 [citado 15 Oct 2016]; 6(11): 593–601. Disponible en: http://www.nature.com/nrneurol/journal/v6/n11/abs/nrneurol.2010.146.html.
Demchuk AM, Dowlatshahi D, Rodriguez-Luna D. Prediction of haematoma growth and outcome in patients with intracerebral haemorrhage using the CT-angiography spot sign (PREDICT): a prospective observational study. Lancet neurology [Internet]. 2012 [citado 15 Oct 2015]; 11(4): 307–14. Disponible en: https://scholar.google.com.cu/scholar?q=Prediction+of+haematoma+growth+and+outcome+in+patients+with+intracerebral+haemorrhage+using+the+CT-angiography+spot+sign+%28PREDICT%29%3A+a+prospective+observational+study&btnG=&hl=es&as_sdt=0%2C5.
Rizos T, Dorner N, Jenetzky E. Spot signs in intracerebral hemorrhage: useful for identifying patients at risk for hematoma enlargement? Cerebrovasc Dis [Internet]. 2013 [citado 16 Oct 2015]; 35(6): 582–9. Disponible en: http://www.karger.com/Article/Abstract/348851.
Venkata Subramanian C, Mlynash M, Finley-Caulfield A. Natural history of perihematomal edema after intracerebral hemorrhage measured by serial magnetic resonance imaging. Stroke [Internet]. 2011 [citado 15 Oct 2015]; 42(1): 73–80. Disponible en: http://www.karger.com/Article/Abstract/348851.
Claude Hemphill J, Greenberg Steven M, Anderson Craig S, Becker K, Bernard R, Bendok Cushman M. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. AHA/ASA Guideline. Stroke [Internet]. 2015 [citado 15 Oct 2016]; 46. Disponible en: http://www.karger.com/Article/Abstract/348851.
Beynon Ch, Schiebel P, Bösel J,.Unterberg AW, Berk O. Minimally invasive endoscopic surgery for treatment of spontaneous intracerebral haematomas. Neurosurgical [Internet]. 2015 [citado 17 Oct 2015]; 38: 421-8. Disponible en: http://link.springer.com/article/10.1007/s10143-015-0606-6.
Almenawer SA, Crevier L, Murty N, Kassam A, Reddy K. Minimal access to deep intracranial lesions using a serial dilatation technique. Neurosurgical [Internet]. 2013 [citado 15 Oct 2015]; 36: 321-30. Disponible en: http://link.springer.com/article/10.1007/s10143-012-0442-x#page-1.
Zhou X, Chen J, Li Q, Ren G, Yao G, Liu M, et al. Minimally invasive surgery for spontaneous supratentorial intracerebral hemorrhage: a meta-analysis of randomized controlledtrials. Stroke [Internet]. 2012; 43: 2923–30. Disponible en: http://link.springer.com/article/10.1007/s10143-012-0442-x#/page-1.
Abdu E, Hanley DF, Newell DW. Minimally invasive treatment for intracerebral hemorrhage. Neurosurg Focus [Internet]. 2012 [citado 16 Oct 2015]; 32: 4. Disponible en: http://thejns.org/doi/abs/10.3171/2012.1.FOCUS11362.
Seng B, Shu E, Figueiredo EG, Amorim LO, Teixeira MJ, Valbuza JS, et al. Decompressive craniectomy: a meta-analysis of influence son intracranial pressure and cerebral perfusionpressure in thetreatment of traumaticbraininjury. A review. J Neurosurg [Internet]. 2012 [citado 16 Oct 2015]; 117: 589–96. Disponible en: http://thejns.org/doi/abs/10.3171/2012.6.JNS101400.
Fung C, Murek M, Z'Graggen WJ, Krähenbühl AK, Gautschi OP, Schucht P, et al. Decompressive hemicraniectomy in patients with supratentorial intracerebral hemorrhage. Stroke [Internet]. 2012 [citado 16 Oct 2015]; 43: 3207–11. Disponible en: http://stroke.ahajournals.org/content/43/12/3207.short.
Gregson BA, Broderick JP, Auer LM, Batjer H, Chen XC, Juvela S, et al. Individual patient data subgroup meta-analysis of surgery for spontaneous supratentorial intracerebral hemorrhage. Stroke [Internet]. 2012 [citado 15 Oct 2015]; 43: 1496–504. Disponible en: doi: 10.1161/STROKEAHA.111.640284.
Delgado Almandoz JE, Yoo AJ, Stone MJ. The spot sign score in primary intracerebral hemorrhageidentifiespatients at highestrisk of in-hospital mortality and a poorout comeamong survivors. Stroke [Internet]. 2010 [citado 15 Oct 2015]; 41(1): 54–60. Disponible en: http://stroke.ahajournals.org/content/43/12/3207.short.
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