Reasons for success in the ENRICH trial of minimally invasive surgery for ICH

Jason Davies, MD, PhD, State University of New York (SUNY) at Buffalo, Buffalo, NY, shares his enthusiasm for the recently published ENRICH trial (NCT02880878) which, for the first time, showed functional benefits from surgical treatment of intracerebral hemorrhage (ICH) compared to standard medical management. The benefit of surgical removal of ICH is a significant topic of debate in the field, as previous trials have failed to demonstrate any positive effects. Dr Davies highlights key aspects of the trial design that may have contributed to the positive results, including enriching for lobar hemorrhages after the lack of benefit for basal ganglia hemorrhages become clear at interim analysis. Additionally, the use of tubular retractors allowed for deeper penetration into the brain while avoiding collateral damage to key areas. Diffusion Tensor Imaging (DTI) was also employed to map white matter tracts. Ongoing trials are further investigating surgical evacuation in anterior basal ganglia hemorrhage subgroups to better determine the benefits for these patients. This interview took place at the American Academy of Neurology (AAN) Annual Meeting 2024 in Denver, CO.
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