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Current trends in the surgical management of spontaneous lobar intracerebral hemorrhage in Canada: A nationwide survey

Published online by Cambridge University Press:  03 April 2025

Catherine Veilleux Open the ORCID record for Catherine Veilleux [Opens in a new window] ,
Andrew M. Demchuk ,
Garnette R. Sutherland ,
Sanju Lama ,
William K. Diprose ,
Alexander D. Rebchuk Open the ORCID record for Alexander D. Rebchuk [Opens in a new window] ,
Matthew E. Eagles Open the ORCID record for Matthew E. Eagles [Opens in a new window] ,
Jenna Smith-Forrester ,
Armaan K. Malhotra  and
Andrew Ajisebutu
...Show all authors
Catherine Veilleux*
Affiliation:
Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
Andrew M. Demchuk
Affiliation:
Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
Garnette R. Sutherland
Affiliation:
Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
Sanju Lama
Affiliation:
Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
William K. Diprose
Affiliation:
Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
Alexander D. Rebchuk
Affiliation:
Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
Matthew E. Eagles
Affiliation:
Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
Jenna Smith-Forrester
Affiliation:
Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada
Armaan K. Malhotra
Affiliation:
Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
Andrew Ajisebutu
Affiliation:
Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
Tristan Brunette-Clément
Affiliation:
Division of Neurosurgery, Department of Surgery, University of Montreal, Montreal, Quebec, Canada
Anne-Marie Langlois
Affiliation:
Division of Neurosurgery, Department of Surgery, University of Sherbrooke, Sherbrooke, Quebec, Canada
Braeden D. Newton
Affiliation:
Division of Neurosurgery, Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
Michael D. Hill
Affiliation:
Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
*
Corresponding author: Catherine Veilleux; Email: Catherine.veilleux@ucalgary.ca
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Abstract

Background:

The Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH) trial demonstrated that minimally invasive surgery to treat spontaneous lobar intracerebral hemorrhage (ICH) improved functional outcomes. We aimed to explore current management trends for spontaneous lobar ICH in Canada to assess practice patterns and determine whether further randomized controlled trials are needed to clarify the role of surgical intervention.

Methods:

Neurologists, neurosurgeons, physiatrists and trainees in these specialties were invited to complete a 16-question survey exploring three areas: (1) current management for spontaneous lobar ICH at their institution, (2) perceived influence of ENRICH on their practice and (3) perceived need for additional clinical trial data. Standard descriptive statistics were used to report categorical variables. The χ2 test was used to compare responses across specialties and career stages.

Results:

The survey was sent to 433 physicians, and 101 (23.3%) responded. Sixty-eight percent of participants reported that prior to publication of the ENRICH trial, spontaneous lobar ICH was primarily managed conservatively, with surgery reserved for life-threatening situations. Forty-three percent of participants did not foresee a significant increase in surgical intervention at their institution. Of neurosurgical respondents, 33% remained hesitant to offer surgical intervention beyond lifesaving operations. Only 5% reported routinely using specifically designed technologies to evacuate ICH. Seventy percent reported that another randomized controlled trial comparing nonsurgical to surgical management for spontaneous lobar ICH is needed.

Conclusions:

There is significant practice variability in the management of spontaneous lobar ICH across Canadian institutions, stressing the need for additional clinical trial data to determine the role of surgical intervention.

Résumé

RÉSUMÉTendances actuelles de la prise en charge chirurgicale de l’hémorragie intracérébrale lobaire spontanée au Canada : une enquête à l’échelle nationale.Contexte :

L’essai clinique ENRICH a démontré qu’une chirurgie peu invasive pour traiter l’hémorragie intracérébrale lobaire (HICL) spontanée améliorait la santé fonctionnelle des patients. Nous avons donc voulu explorer les tendances actuelles de la prise en charge de l’HICL spontanée au Canada afin d’évaluer les modes de pratique et de déterminer si d’autres essais cliniques randomisés sont nécessaires pour clarifier le rôle de l’intervention chirurgicale.

Méthodes :

Des neurologues, neurochirurgiens, physiatres et stagiaires de ces spécialités ont été invités à répondre à un questionnaire de 16 questions portant sur trois aspects : (1) la prise en charge actuelle de l’HICL spontanée dans leur établissement ; (2) l’influence perçue de l’essai clinique ENRICH sur leur pratique ; et (3) la perception que des données tirées d’essais cliniques supplémentaires sont nécessaires. Des statistiques descriptives standards ont été utilisées pour rendre compte des variables catégorielles. Le test du chi-carré (χ2) a été utilisé pour comparer entre elles les réponses des spécialistes et les étapes de leur carrière.

Résultats :

Notre questionnaire a été envoyé à 433 médecins parmi lesquels 101 (23,3 %) y ont répondu. Soixante-huit pour cent des participants ont déclaré que l’HICL spontanée était principalement traitée de manière conservatrice avant la publication de l’essai clinique ENRICH, la chirurgie étant réservée aux situations mettant en jeu le pronostic vital. Quarante-trois pour cent des participants ne prévoyaient pas d’augmentation notable des interventions chirurgicales au sein de leur établissement. Parmi les neurochirurgiens interrogés, 33 % hésitent encore à proposer une intervention chirurgicale au-delà des opérations de sauvetage. Seuls 5 % d’entre eux ont aussi déclaré utiliser systématiquement des technologies spécifiquement conçues pour évacuer les HICL spontanées. Enfin, soixante-dix pour cent ont déclaré qu’un autre essai clinique randomisé comparant la prise en charge non chirurgicale à la prise en charge chirurgicale de l’HICL spontanée était nécessaire.

Conclusions :

La prise en charge de l’HICL spontanée varie considérablement d’un établissement de santé canadien à l’autre, ce qui souligne la nécessité de disposer de données tirées d’essais cliniques supplémentaires pour déterminer le rôle de l’intervention chirurgicale.

Information

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 53 , Issue 1 , January 2026 , pp. 96 - 103
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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