Evidence map›Paper›PMID 27758940›Full record

Trial reportStroke2016

ICES (Intraoperative Stereotactic Computed Tomography-Guided Endoscopic Surgery) for Brain Hemorrhage: A Multicenter Randomized Controlled Trial.

Paul Vespa, Daniel Hanley, Joshua Betz, Alan Hoffer, Johnathan Engh, Robert Carter, Peter Nakaji, Chris Ogilvy, Jack Jallo, Warren Selman and 7 more

Erratum issued 2 registry-linked trialsOpen access · greenAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Stroke, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 2 registered trials, which are not on this map. Cited by 89 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
89citing papers in PubMed, 9 pooled it
9.4field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00224770 phase2completednot on this map

Minimally Invasive Surgery and rtPA for Intracerebral Hemorrhage Evacuation

TypeinterventionalSponsorDaniel HanleyRan2005 to 2013Enrolled141ConditionsIntracerebral HemorrhageArmsMIS+Cathflo Activase (drug), Intraoperative stereotactic CT-Guided Endoscopic Surgery
NCT03414307 nawithdrawnnot on this mapstarted 2020, after this paper: background citation

ROSA Stereotactic Robot-assisted Intracerebral Hemorrhage Clot Evacuation

TypeinterventionalSponsorZimmer BiometRan2020 to 2020Enrolled0ConditionsIntracerebral HematomaArmsIntracerebral catheter placement, Robot-assisted intracerebral catheter
3 · Its place in the literature

Who cites it

89 citing papers in PubMed, 9 syntheses or guidelines pooled it, 197 citations in OpenAlex.

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  4. Surgery for spontaneous supratentorial intracerebral haemorrhage.The Cochrane database of systematic reviews · 2025
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  20. Controversies in Treatment Methodologies in Cerebrovascular Surgery.Advances and technical standards in neurosurgery · 2026
    Review

29 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors at 7 institutions in 2 countries.

Paul VespaFrom the Departments of Neurosurgery and Neurology, David Geffen School of Medicine at University of California, Los Angeles (P.V., J.S., N. Martin); Department of Neurology, Johns Hopkins University, Baltimore, MD (D.H., J.B., A.B.-H., K.L., N. McBee, R.E.T.); Department of Neurosurgery, Case Western University (A.H., W.S.); Department of Neurosurgery, University of Pittsburgh, PA (J.E., P.N.); Department of Neurosurgery, University of California, San Diego (R.C.); Department of Neurosurgery, Harvard University, Massachusetts General Hospital, Boston (C.O.); and Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA (J.J.). Pvespa@mednet.ucla.edu.
Daniel HanleyFrom the Departments of Neurosurgery and Neurology, David Geffen School of Medicine at University of California, Los Angeles (P.V., J.S., N. Martin); Department of Neurology, Johns Hopkins University, Baltimore, MD (D.H., J.B., A.B.-H., K.L., N. McBee, R.E.T.); Department of Neurosurgery, Case Western University (A.H., W.S.); Department of Neurosurgery, University of Pittsburgh, PA (J.E., P.N.); Department of Neurosurgery, University of California, San Diego (R.C.); Department of Neurosurgery, Harvard University, Massachusetts General Hospital, Boston (C.O.); and Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA (J.J.).
Joshua BetzFrom the Departments of Neurosurgery and Neurology, David Geffen School of Medicine at University of California, Los Angeles (P.V., J.S., N. Martin); Department of Neurology, Johns Hopkins University, Baltimore, MD (D.H., J.B., A.B.-H., K.L., N. McBee, R.E.T.); Department of Neurosurgery, Case Western University (A.H., W.S.); Department of Neurosurgery, University of Pittsburgh, PA (J.E., P.N.); Department of Neurosurgery, University of California, San Diego (R.C.); Department of Neurosurgery, Harvard University, Massachusetts General Hospital, Boston (C.O.); and Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA (J.J.).
Alan HofferFrom the Departments of Neurosurgery and Neurology, David Geffen School of Medicine at University of California, Los Angeles (P.V., J.S., N. Martin); Department of Neurology, Johns Hopkins University, Baltimore, MD (D.H., J.B., A.B.-H., K.L., N. McBee, R.E.T.); Department of Neurosurgery, Case Western University (A.H., W.S.); Department of Neurosurgery, University of Pittsburgh, PA (J.E., P.N.); Department of Neurosurgery, University of California, San Diego (R.C.); Department of Neurosurgery, Harvard University, Massachusetts General Hospital, Boston (C.O.); and Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA (J.J.).
Johnathan EnghFrom the Departments of Neurosurgery and Neurology, David Geffen School of Medicine at University of California, Los Angeles (P.V., J.S., N. Martin); Department of Neurology, Johns Hopkins University, Baltimore, MD (D.H., J.B., A.B.-H., K.L., N. McBee, R.E.T.); Department of Neurosurgery, Case Western University (A.H., W.S.); Department of Neurosurgery, University of Pittsburgh, PA (J.E., P.N.); Department of Neurosurgery, University of California, San Diego (R.C.); Department of Neurosurgery, Harvard University, Massachusetts General Hospital, Boston (C.O.); and Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA (J.J.).
Robert CarterFrom the Departments of Neurosurgery and Neurology, David Geffen School of Medicine at University of California, Los Angeles (P.V., J.S., N. Martin); Department of Neurology, Johns Hopkins University, Baltimore, MD (D.H., J.B., A.B.-H., K.L., N. McBee, R.E.T.); Department of Neurosurgery, Case Western University (A.H., W.S.); Department of Neurosurgery, University of Pittsburgh, PA (J.E., P.N.); Department of Neurosurgery, University of California, San Diego (R.C.); Department of Neurosurgery, Harvard University, Massachusetts General Hospital, Boston (C.O.); and Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA (J.J.).
Peter NakajiFrom the Departments of Neurosurgery and Neurology, David Geffen School of Medicine at University of California, Los Angeles (P.V., J.S., N. Martin); Department of Neurology, Johns Hopkins University, Baltimore, MD (D.H., J.B., A.B.-H., K.L., N. McBee, R.E.T.); Department of Neurosurgery, Case Western University (A.H., W.S.); Department of Neurosurgery, University of Pittsburgh, PA (J.E., P.N.); Department of Neurosurgery, University of California, San Diego (R.C.); Department of Neurosurgery, Harvard University, Massachusetts General Hospital, Boston (C.O.); and Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA (J.J.).
Chris OgilvyFrom the Departments of Neurosurgery and Neurology, David Geffen School of Medicine at University of California, Los Angeles (P.V., J.S., N. Martin); Department of Neurology, Johns Hopkins University, Baltimore, MD (D.H., J.B., A.B.-H., K.L., N. McBee, R.E.T.); Department of Neurosurgery, Case Western University (A.H., W.S.); Department of Neurosurgery, University of Pittsburgh, PA (J.E., P.N.); Department of Neurosurgery, University of California, San Diego (R.C.); Department of Neurosurgery, Harvard University, Massachusetts General Hospital, Boston (C.O.); and Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA (J.J.).
Jack JalloFrom the Departments of Neurosurgery and Neurology, David Geffen School of Medicine at University of California, Los Angeles (P.V., J.S., N. Martin); Department of Neurology, Johns Hopkins University, Baltimore, MD (D.H., J.B., A.B.-H., K.L., N. McBee, R.E.T.); Department of Neurosurgery, Case Western University (A.H., W.S.); Department of Neurosurgery, University of Pittsburgh, PA (J.E., P.N.); Department of Neurosurgery, University of California, San Diego (R.C.); Department of Neurosurgery, Harvard University, Massachusetts General Hospital, Boston (C.O.); and Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA (J.J.).
Warren SelmanFrom the Departments of Neurosurgery and Neurology, David Geffen School of Medicine at University of California, Los Angeles (P.V., J.S., N. Martin); Department of Neurology, Johns Hopkins University, Baltimore, MD (D.H., J.B., A.B.-H., K.L., N. McBee, R.E.T.); Department of Neurosurgery, Case Western University (A.H., W.S.); Department of Neurosurgery, University of Pittsburgh, PA (J.E., P.N.); Department of Neurosurgery, University of California, San Diego (R.C.); Department of Neurosurgery, Harvard University, Massachusetts General Hospital, Boston (C.O.); and Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA (J.J.).
Amanda Bistran-HallFrom the Departments of Neurosurgery and Neurology, David Geffen School of Medicine at University of California, Los Angeles (P.V., J.S., N. Martin); Department of Neurology, Johns Hopkins University, Baltimore, MD (D.H., J.B., A.B.-H., K.L., N. McBee, R.E.T.); Department of Neurosurgery, Case Western University (A.H., W.S.); Department of Neurosurgery, University of Pittsburgh, PA (J.E., P.N.); Department of Neurosurgery, University of California, San Diego (R.C.); Department of Neurosurgery, Harvard University, Massachusetts General Hospital, Boston (C.O.); and Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA (J.J.).
Karen LaneFrom the Departments of Neurosurgery and Neurology, David Geffen School of Medicine at University of California, Los Angeles (P.V., J.S., N. Martin); Department of Neurology, Johns Hopkins University, Baltimore, MD (D.H., J.B., A.B.-H., K.L., N. McBee, R.E.T.); Department of Neurosurgery, Case Western University (A.H., W.S.); Department of Neurosurgery, University of Pittsburgh, PA (J.E., P.N.); Department of Neurosurgery, University of California, San Diego (R.C.); Department of Neurosurgery, Harvard University, Massachusetts General Hospital, Boston (C.O.); and Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA (J.J.).
Nichol McBeeFrom the Departments of Neurosurgery and Neurology, David Geffen School of Medicine at University of California, Los Angeles (P.V., J.S., N. Martin); Department of Neurology, Johns Hopkins University, Baltimore, MD (D.H., J.B., A.B.-H., K.L., N. McBee, R.E.T.); Department of Neurosurgery, Case Western University (A.H., W.S.); Department of Neurosurgery, University of Pittsburgh, PA (J.E., P.N.); Department of Neurosurgery, University of California, San Diego (R.C.); Department of Neurosurgery, Harvard University, Massachusetts General Hospital, Boston (C.O.); and Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA (J.J.).
Jeffery SaverFrom the Departments of Neurosurgery and Neurology, David Geffen School of Medicine at University of California, Los Angeles (P.V., J.S., N. Martin); Department of Neurology, Johns Hopkins University, Baltimore, MD (D.H., J.B., A.B.-H., K.L., N. McBee, R.E.T.); Department of Neurosurgery, Case Western University (A.H., W.S.); Department of Neurosurgery, University of Pittsburgh, PA (J.E., P.N.); Department of Neurosurgery, University of California, San Diego (R.C.); Department of Neurosurgery, Harvard University, Massachusetts General Hospital, Boston (C.O.); and Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA (J.J.).
Richard E ThompsonFrom the Departments of Neurosurgery and Neurology, David Geffen School of Medicine at University of California, Los Angeles (P.V., J.S., N. Martin); Department of Neurology, Johns Hopkins University, Baltimore, MD (D.H., J.B., A.B.-H., K.L., N. McBee, R.E.T.); Department of Neurosurgery, Case Western University (A.H., W.S.); Department of Neurosurgery, University of Pittsburgh, PA (J.E., P.N.); Department of Neurosurgery, University of California, San Diego (R.C.); Department of Neurosurgery, Harvard University, Massachusetts General Hospital, Boston (C.O.); and Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA (J.J.).
Neil MartinFrom the Departments of Neurosurgery and Neurology, David Geffen School of Medicine at University of California, Los Angeles (P.V., J.S., N. Martin); Department of Neurology, Johns Hopkins University, Baltimore, MD (D.H., J.B., A.B.-H., K.L., N. McBee, R.E.T.); Department of Neurosurgery, Case Western University (A.H., W.S.); Department of Neurosurgery, University of Pittsburgh, PA (J.E., P.N.); Department of Neurosurgery, University of California, San Diego (R.C.); Department of Neurosurgery, Harvard University, Massachusetts General Hospital, Boston (C.O.); and Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA (J.J.).
ICES Investigators
Western University · CAUniversity of California, San Diego · USUniversity of California, Los Angeles · USHarvard University · USJohns Hopkins University · USMassachusetts General Hospital · USUniversity of Pittsburgh · US

Funding

UCLA SPOTRIAS CENTER APPLICATION RENEWAL-PROGRAM PROJECTP50NS044378 · NINDS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI VINTERS, HARRY V. · 2003 to 2012
$17.2M
ICH Removal: Minimally Invasive Surgery + rt-PAR01NS046309 · NINDS · JOHNS HOPKINS UNIVERSITY · PI HANLEY, DANIEL F · 2005 to 2011
$9.1M
NINDS NIH HHS P50 NS044378NINDS NIH HHS R01 NS046309
6 · The paper itself

Abstract

background and purposeIntracerebral hemorrhage (ICH) is a devastating disease without a proven therapy to improve long-term outcome. Considerable controversy about the role of surgery remains. Minimally invasive endoscopic surgery for ICH offers the potential of improved neurological outcome.

methodsWe tested the hypothesis that intraoperative computerized tomographic image-guided endoscopic surgery is safe and effectively removes the majority of the hematoma rapidly. A prospective randomized controlled study was performed on 20 subjects (14 surgical and 4 medical) with primary ICH of >20 mL volume within 48 hours of ICH onset. We prospectively used a contemporaneous medical control cohort (n=36) from the MISTIE trial (Minimally Invasive Surgery and r-tPA for ICH Evacuation). We evaluated surgical safety and neurological outcomes at 6 months and 1 year.

resultsThe intraoperative computerized tomographic image-guided endoscopic surgery procedure resulted in immediate reduction of hemorrhagic volume by 68±21.6% (interquartile range 59-84.5) within 29 hours of hemorrhage onset. Surgery was successfully completed in all cases, with a mean operative time of 1.9 hours (interquartile range 1.5-2.2 hours). One surgically related bleed occurred peri-operatively, but no patient met surgical safety stopping threshold end points for intraoperative hemorrhage, infection, or death. The surgical intervention group had a greater percentage of patients with good neurological outcome (modified Rankin scale score 0-3) at 180 and 365 days as compared with medical control subjects (42.9% versus 23.7%; P=0.19).

conclusionsEarly computerized tomographic image-guided endoscopic surgery is a safe and effective method to remove acute intracerebral hematomas, with a potential to enhance neurological recovery. CLINICAL

trial registrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00224770.

Indexed as

Outcome and Process Assessment, Health CareCerebral HemorrhageFemaleFollow-Up StudiesHumansMaleMinimally Invasive Surgical ProceduresNeuroendoscopyPilot ProjectsSurgery, Computer-AssistedTomography, X-Ray Computedcomaendoscopic surgeryhemorrhagicintracerebral hemorrhagestroke

Identifiers

PMID27758940
PMCPMC6168060
OpenAlexW2529032415

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.