The Management of Spontaneous Intracerebral Hemorrhage: Medical Versus Surgical Therapy for Spontaneous Intracerebral Hemorrhage

ABSTRACT

The results of treatment for 248 patients with spontaneous intracerebral hemorrhage are described. Spontaneous intracerebral hemorrhages are classified into primary(215 patients) and secondary(33 patients) hemorrhages. Most of the secondary hemorrhages were located in the subcortical area(64%). In the Non-treated group, eighty patients died immediately after diagnosis. In the treated group, the overall mortality was 5% in primary hemorrhages and 15% in secondary hemorrhages, and the percentages of hypertensive intracerebral hemorrhage patients returning to full-time work or independent life without disability or with minimal disability were 30% in putaminal hemorrhages, 86% in caudate hemorrhages, 44% in thalamic hemorrhages, 61% in subcortical hemorrhages, 78% in cerebellar hemorrhages and 40% in brainstem hemorrhages respectively. This study showed that surgical treatment did not give better result over conservative treatment in the management of hypertensive supratentorial and brainstem hemorrhage. However hypertensive caudate and cerebellar hemorrhage were associated with favorable outcomes regardless of the mode of therapy chosen. In severe hemorrhages, surgery may improve the length of survival, but the quality of life remains poor. The authors have shown again that aspiration surgery for hypertensive cerebellar hemorrhage is a valuable alternative to craniotomy.