New hope for patients with brain hemorrhages
Through participation in the NIH-sponsored MINUTE clinical trial, Atlantic Brain and Spine is helping evaluate whether ultra-early, minimally invasive clot evacuation can improve care for patients with deep intracerebral hemorrhages.
A new treatment strategy for one of the most dangerous forms of stroke
For decades, patients suffering spontaneous brain hemorrhages have faced limited options and uncertain outcomes. Treatment has often involved careful monitoring and medical management or an invasive operation requiring the removal of part of the skull.
Atlantic Brain and Spine is now participating in the MINUTE clinical trial, a national study evaluating minimally invasive neuroendoscopic evacuation as an ultra-early treatment for selected patients with deep intracerebral hemorrhages.
As surgical principal investigator for the trial at Morristown Medical Center and Overlook Medical Center, fellowship-trained neurosurgeon Guilherme Barros, MD, is helping bring this research to patients across New Jersey.
What happens during an intracerebral hemorrhage?
When a blood vessel ruptures within the brain, blood collects inside the surrounding tissue. The accumulating blood can create pressure, damage nearby brain structures and interfere with critical neurological functions.
A blood vessel ruptures
Bleeding begins directly within the brain rather than from a blocked blood vessel, as occurs in an ischemic stroke.
Pressure builds
The resulting collection of blood, called a hematoma, can compress and injure surrounding brain tissue.
Damage can progress
The longer the clot and pressure remain, the greater the concern for additional injury and loss of neurological function.
Also called ICH or hemorrhagic stroke
Treatment depends on the hemorrhage’s size and location, neurological symptoms, the patient’s overall health and whether an underlying vascular condition caused the bleeding.
Learn more about intracerebral hemorrhage →Removing the clot through a much smaller opening
The technique being studied is called SCUBA, or Stereotactic Intracerebral Hemorrhage Underwater Blood Aspiration.
Instead of using a large incision for a conventional craniotomy or craniectomy, the neurosurgeon creates a small opening in the skull and carefully guides an endoscope to the hemorrhage.
The endoscope provides a direct view of the clot and surrounding brain. Continuous irrigation maintains a clear surgical field while a specialized aspiration device removes the clot or breaks it into smaller fragments that can be removed through the narrow channel.
A short incision may be placed near the forehead, eyebrow crease or behind the hairline.
Image guidance helps the surgeon reach the hemorrhage while limiting disruption to healthy tissue.
Irrigation, visualization and controlled aspiration allow the clot to be removed through the small channel.
The goal is to relieve pressure while minimizing additional injury
Minimally invasive evacuation is designed to remove the hematoma through a smaller surgical corridor. Researchers are evaluating whether earlier clot removal can support better recovery in appropriately selected patients.
Limit tissue disruption
A narrow endoscopic corridor may reduce the amount of healthy brain tissue affected while reaching the clot.
See the hemorrhage clearly
The endoscope provides a direct view of the hematoma and surrounding tissue throughout the evacuation.
Relieve pressure sooner
MINUTE is studying intervention within a significantly shorter time window than many previous hemorrhage trials.
Begin the next phase earlier
Earlier stabilization may allow selected patients to move toward extubation, ICU discharge and rehabilitation sooner.
Building on evidence while answering a new question
MINUTE is not repeating the work of earlier studies. It is evaluating a different patient group, surgical technique and treatment timeline.
The ENRICH trial
ENRICH compared minimally invasive surgical clot evacuation plus guideline-based medical management with medical management alone.
The study found better functional outcomes at 180 days in the overall population, with the observed benefit driven by patients with lobar, or more superficial, hemorrhages.
Review the published ENRICH study →The MINUTE trial
MINUTE is evaluating ultra-early SCUBA evacuation for selected patients with deep basal ganglia hemorrhages.
The study is designed to determine whether this earlier, endoscopic intervention is safe and improves outcomes when compared with standard medical management.
Learn more about the MINUTE trial →Why the MINUTE trial’s timeline is different
The defining feature of MINUTE is how quickly patients must be evaluated, enrolled and treated after the hemorrhage begins.
Rapid stroke evaluation
Emergency imaging identifies the hemorrhage, its location and whether another vascular condition may have caused it.
Evaluation and randomization
Potentially eligible patients are evaluated against the study criteria and may be randomized within two hours of arriving in the emergency department.
Surgery begins quickly
Patients assigned to the surgical group undergo endoscopic evacuation alongside guideline-based medical management.
Ultra-early treatment
The procedure must occur within 16 hours of the patient’s last known well time.
Ultra-early care requires more than surgical expertise
Meeting MINUTE’s narrow treatment window requires rapid coordination across emergency medicine, stroke neurology, neurocritical care, imaging, anesthesia and neurosurgery.
Morristown Medical Center and Overlook Medical Center are Comprehensive Stroke Centers with established rapid-response protocols and advanced imaging available around the clock.
At Morristown Medical Center, eligible procedures can be performed in a hybrid angiography operating room. This allows cerebral angiography, endoscopic evacuation and intraoperative CT imaging to occur in one setting, reducing the need to transport a critically ill patient between multiple departments.
Specialized technology for a narrow surgical corridor
Neuroendoscopy
The endoscope provides direct visualization of the clot and surrounding brain through a small opening.
Continuous irrigation
Fluid maintains a clear operative field so the surgeon can distinguish the hematoma from normal tissue.
Controlled aspiration
The Artemis Neuro Evacuation Device can aspirate the clot or break it into smaller fragments for removal.
Specialized experience with the SCUBA technique
SCUBA remains a highly specialized procedure that is not yet widely practiced. Multiple ABS cerebrovascular neurosurgeons have experience with the technique and are participating in the MINUTE trial.
Guilherme Barros, MD
Fellowship-trained cerebrovascular and endovascular neurosurgeon with specialized training in minimally invasive endoscopic clot evacuation.
Meet Dr. Barros → CEREBROVASCULAR NEUROSURGEONRonald P. Benitez, MD
Senior open and endovascular cerebrovascular specialist participating in the MINUTE clinical trial.
Meet Dr. Benitez → CEREBROVASCULAR NEUROSURGEONKyle T. Chapple, MD
Neurosurgeon experienced in open, endovascular and minimally invasive treatment of complex cerebrovascular conditions.
Meet Dr. Chapple →Bringing minimally invasive hemorrhage care to New Jersey
Before the launch of the MINUTE trial, Dr. Barros used the SCUBA technique to treat patients at Overlook Medical Center and became the first neurosurgeon to perform the procedure at Morristown Medical Center.
The team’s early experience has included patients progressing toward extubation, ICU discharge and rehabilitation after treatment. These individual clinical experiences are encouraging, but the MINUTE trial is needed to rigorously evaluate safety and outcomes in a defined patient population.
Patients who do not meet the trial’s criteria may still be evaluated separately for surgery when the treating neurosurgeon determines that it is clinically appropriate.
The trial is part of emergency hospital care
MINUTE is not a trial that patients enroll in through a routine website appointment. Potential participants are identified and evaluated by the hospital stroke team after arriving with an acute intracerebral hemorrhage.
Call 911 immediately
Sudden weakness, numbness, difficulty speaking, severe headache, loss of balance or changes in consciousness may indicate a stroke.
Request a specialist evaluation
ABS can help patients and families understand a diagnosis, ongoing care needs and potential follow-up treatment options.
Explore neurovascular care
Learn about the specialists, conditions and advanced treatments available through Atlantic Brain and Spine.
Expert evaluation, advanced treatment and clinical research
If you or a loved one is recovering from a stroke or needs guidance about a cerebrovascular diagnosis, our specialists can help you understand the available options.
