Intracerebral haematoma: Operative versus non-operative

Abstract

Background: Spontaneous supratentorial intracerebral haemorrhage (ICH) accounts for 10-30% of all strokes resulting in a high mortality and major morbidity. Although guidelines for medical treatment and surgical intervention for ICH are available, selection of patients for surgery in this,group of patients is controversial and varies greatly throughout the world. Objective: In the current study, we aimed to review our selection criteria for treatment and their management results. Methods: We had prospectively collected the data of patients admitted to our centre with spontaneous supratentorial ICH in a 2-year period (January 2001-December 2002). We divided the patients into three main groups according to the anatomical site: putaminal, subcortical and deep basal ganglia. Surgical treatment was limited to patients aged below 65 years, with a clot size between 30 and 100 mL, and motor scores of normal flexion to localizing to pain. Results: One hundred and twenty-four patients were recruited in the current study. Thirty-four patients managed by early surgery had an 18% mortality, 29% were independent and 53% dependent at 6 months. Early surgery for subcortical haematoma carried the best prognosis (42% achieved independence), whereas deep basal ganglia haematoma carried the worst prognosis (none achieved independence). Conclusions: Although this prospective audit was not intended to be a case-control study, data from the present study support early surgery for patients with putaminal and subcortical haematomas with a clot size larger than 50 mL. For smaller haematomas less than 30 mL, conservative management is associated with a superior clinical outcome.