Spontaneous intracerebral haemorrhage: a surgical dilemma

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.