The optimal management, surgical or otherwise, of a patient following a spo
ntaneous intracerebral haemorrhage (ICH) remains controversial. A survey of
British neurosurgeons was carried out to assess current attitudes and prac
tice. Patient management was most consistently influenced by the depth (71%
agreement), dominance (74.3% agreement) and site (44.7%) of the haematoma.
Almost half of neurosurgeons said they would evacuate an ICH in a deterior
ating patient, but management choice was very varied in stable patients. Ho
wever, 80% of the same respondents felt evacuation was helpful in reducing
mortality, and 71.3% morbidity. Fifteen per cent of respondents were not in
fluenced by the size of an ICH, but 31% would readily operate on haematomas
with volumes of between 50 and 80 mi. Over 30% felt that there was no opti
mal time for surgical evacuation, but 66.9% felt delayed evacuation was hel
pful. Premorbid dependency was a stronger influence than age on management
choice. Despite these variations, over half felt that they were consistent
in their treatment of ICH. However, 81% expressed surgical uncertainty. Fur
thermore, respondents demonstrated a significant tendency to intervene surg
ically more readily in ICH related to aneurysm or AVM. Results from a prosp
ective randomized controlled trial to assess the role of surgery are urgent
ly needed.