Minimally invasive neurosurgery & telesurgery changing the dynamics of SIH management: Experts

New Delhi: Spontaneous Intracerebral Haemorrhage (SIH) is a condition characterized by bleeding into the brain tissue and accounts for 85% of haemorrhagic stroke cases. It contributes to approximately 33% of total stroke patients and is responsible for approximately 50% of stroke-related deaths.

Dr. Manish Vaish, Senior Director, Neurosurgery, at Max Super Speciality Hospital, Vaishali says, “Spontaneous Intracerebral Haemorrhage is a life-threatening medical condition that contributes significantly to deaths and disability. Over 60% of SIH cases are related to chronic hypertension. SIH presents itself as a focal neurological deficit which is determined by the location of the bleeding and subsequent oedema. The most commonly affected locations are the posterior fossa, pons, basal ganglia, and thalamus. Focal neurological damage is accompanied by decreasing consciousness. Other common signs and symptoms include headache, seizures, nausea and high diastolic blood pressure.”

SIH is an emergency condition and high mortality is often due to delays in access to a medical facility capable of managing the condition. Management of SIH is often a combination of medical and surgical modalities; where medical management is important to maintain the airway, breathing, providing circulatory support and managing hypertension and surgical treatment is used to relieve the blood clots from the brain and release the pressure on the brain due to hematoma.

Dr. Yashpal Singh Bundela, Senior Consultant, Brain and Spine Ppl, New Delhi says, “The aim of surgical management in SIH cases is to evacuate the blood clot and release pressure from the brain tissue to prevent neurological damage. Patients with a clot size greater than 3 cm causing compression of the brainstem, decreased consciousness and hydrocephalous and idea for surgical intervention. In patients who do not respond to medical management, surgery can be considered. Traditionally, craniotomy has remained the treatment of choice for the management of intracerebral haemorrhages (ICH), which offered improved survival rates; however, morbidity remains high. Recent advances in the field of neurosurgery have opened new avenues for the management and now minimally invasive surgeries are replacing traditional craniotomies for better patient outcomes.”

“The ideal treatment for SIH is one of the most controversial topics in the field of neurosurgery. ICH is a condition with high mortality and morbidity and imposes a high economic burden on countries worldwide. Therefore, there are continuous efforts to find the answers for the best possible treatment modalities for these patients. Minimally invasive surgery has evolved as the latest development in the field and has shown promising results in SIH patients. Like other surgical procedures, it is important to get a competent team to perform the procedure to best patient outcomes.”, added Dr Vaish.

“India is a diverse country and approx. 60% of the population resides in rural areas. Access to dedicated neurosurgery teams is often a challenge. Intracerebral haemorrhage is an emergency medical condition and delay in treatment often results in lifelong disability and in some cases loss of life. Telesurgery can be instrumental in saving many patients in rural settings and preventing disability. A neurosurgery team can guide general surgeons through technology to perform an initial procedure that gives time widow to relocate the patient in the care of a specialised neurosurgery team.”, added Dr Bundela.

MIS and Telesurgery have the potential of creating landmark changes in the field of neurosurgery, which will help in saving many lives realizing the dream of holistic access to healthcare for every citizen of India irrespective of their geography.