SURGERY FOR INTRACEREBRAL HEMORRHAGE

Intracerebral hemorrhage (ICH) represents 8 to 15% of all strokes in t he United States and 20 to 30% of all strokes in Japan and china. Alth ough ICH represents a relatively small fraction of total strokes, it i s a formidable disease, with a 30-day mortality rate two- to sixfold h igher than that for ischemic stroke. Furthermore, it is a major cause of disability, with only 20% of patients becoming independent at 6 mon ths. The most common risk factors for ICH are age, hypertension, and a myloid angiopathy, which are associated with damage to and weakening o f the arterial/arteriolar wall leading to vessel rupture. The patholog y is a dynamic one that continues to evolve over the first few days af ter onset. In 20 to 30% of ICH, clot volume increases over the first 2 4 hours and is generally associated with neurologic worsening. The fin al outcome from ICH is related not only to clot volume, compression, a nd destruction but also to potential neurotoxicity from the blood degr adation products and associated neuronal ischemia. The treatment of IC H has been one of the most controversial and least well-studied areas from a medical or surgical perspective. Surgical treatment has evolved over the years and can be grouped into open and stereotactically guid ed surgery for hematoma evacuation. Seven thousand operations per year are performed in the United States for hematoma evacuation, although this approach has not been adequately investigated. Adjuvant medical t herapies with neuroprotective agents require further investigation and may potentially have additive benefits.