Revisiting Traumatic Intracerebral Hemorrhage in the Context of ENRICH: Illustrative Cases

Authors

Erik Werheim
Brendan McShane
Zachary Sokol, Thomas Jefferson UniversityFollow
Theodore Hannah
Robert Ziechmann, Thomas Jefferson UniversityFollow
Phillip Villaneuva

Document Type

Article

Publication Date

5-26-2025

Comments

This article is the author's final published version in Journal of Neurosurgery: Case Lessons, Volume 9, Issue 21, May 2025, Article number CASE24591.

The published version is available at https://doi.org/10.3171/CASE24591. Copyright © The Author(s).

Abstract

BACKGROUND: Traumatic intracerebral hemorrhage (tICH) is a common form of intracranial hemorrhage after traumatic brain injury (TBI). The role of surgical intervention in tICH remains a subject of discussion. Recent trials, such as Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH), have shown the efficacy of minimally invasive clot evacuation for non-tICH for hemorrhages with volumes of 30-80 mL. The generalizability of ENRICH to tICH remains unclear; however, it demonstrates the need for rigorous studies evaluating the efficacy of surgical intervention in tICH versus medical management.

OBSERVATIONS: Here the authors present 2 cases of tICH, both in the dominant temporal lobe, of similar volumes. One case was managed surgically and the other medically. The decision to operate on the first patient was due to interval enlargement of the hematoma. In the second patient, the decline in neurological examination was attributable to perilesional edema, and the decision was made to manage the patient medically. Both patients ultimately had good outcomes.

LESSONS: The management of patients with tICH remains challenging. However, having a sophisticated understanding of the biological processes underlying the patient's presentation is paramount in delivering optimal management. Larger and more granular studies are needed in order to further clarify the role of operative intervention in patients with tICH. https://thejns.org/doi/10.3171/CASE24591.

Recommended Citation

Werheim, Erik; McShane, Brendan; Sokol, Zachary; Hannah, Theodore; Ziechmann, Robert; and Villaneuva, Phillip, "Revisiting Traumatic Intracerebral Hemorrhage in the Context of ENRICH: Illustrative Cases" (2025). Department of Surgery Faculty Papers. Paper 295.
https://jdc.jefferson.edu/surgeryfp/295

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

PubMed ID

40418887

Language

English