Management of ICH; AVM; Cavernous Angioma; Cavernoma

SUMMARY: Dr. Allyene notes that 15% of stokes that occur in patients are Intra Cerebral Hemorrhage (ICH). ICH is a major health problem worldwide primarily caused by hypertension. Small series of patients with ICH, were reported in the literature but few large studies. Most advocated delayed surgery. There are guidelines from a 2022 American Heart Association study on the management of ICH which he details. Deteriorating CNS condition is a reason for surgery and also in posterior fossa hemorrhage with more than 15 cc volume. Hypertension should be slowly reduced to 130-150 to avoid ischemia in hypertensive patients. A recent NEJM Study suggested that early surgery using minimally invasive techniques with endoscopy, was better than no surgery with 50% reduction in mortality. Devices are being produced which make this approach easier. However, some discussants did not find that approach useful. Others use intra-operative ultrasound with high success. Members of the global audience, depending upon their local circumstances, performed surgery encompassing all of these approaches including standard craniotomy to Minimally Invasive approaches frontally or over the lesion location. For ICH in AVMs, he detailed videos with excellent techniques. The literature reports early or late surgery for ruptured AVMs. For Cavernous Malformations which bleed, surgery is the best course of treatment. There are other reports in SNI Digital® of the genetic causes of rare AVMs with a unique gene variation and in Cavernous malformations with precision molecular treatments, projecting the future treatments of these diseases. Dr. Ausman described the work of Dr. Buzz Hoff who, in the past, investigated the harmful effects of secondary metabolic and cellular damage created by the blood and its products in the brain, indicating that early surgery would be required to treat this disease successfully besides controlling hypertension. Message: "Do the best you can with what you have." (SEARCH ICH or Cavernous Malformations). (11/10/24 JIA)