Spontaneous intracerebral haemorrhage: a surgical dilemma

• Published in: British journal of neurosurgery Vol. 13; no. 4; pp. 389 - 394
• Main Authors: FERNANDES, H. M, MENDELOW, A. D
• Format: Journal Article
• Language: English
• Published: Abingdon Informa UK Ltd 01.08.1999; Taylor & Francis; Taylor & Francis Ltd
• Subjects: Biological and medical sciences; Brain; Cerebral Hemorrhage - surgery; Hematoma - surgery; Hemorrhage; Humans; Intracerebral Haemorrhage;Observer Variation;Questionnaire;Surgery; Medical sciences; Medical Staff, Hospital; Neurology; Neurosurgical Procedures - methods; Observer Variation; Patient Care; Practice Patterns, Physicians; Questionnaires; Surgery; Surveys and Questionnaires; United Kingdom; Vascular diseases and vascular malformations of the nervous system; United Kingdom; Europe; Vascular disease; Human; Nervous system diseases; Questionnaire; Treatment; Surgery; Cerebral hemorrhage; Spontaneous; Central nervous system disease; Cardiovascular disease; Cerebrovascular disease; Cerebral disorder
• ISSN: 0268-8697; 1360-046X
• DOI: 10.1080/02688699943501

The optimal management, surgical or otherwise, of a patient following a spontaneous intracerebral haemorrhage (ICH) remains controversial. A survey of British neurosurgeons was carried out to assess current attitudes and practice. 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 deteriorating patient, but management choice was very varied in stable patients. However, 80% of the same respondents felt evacuation was helpful in reducing mortality, and 71.3% morbidity. Fifteen per cent of respondents were not influenced by the size of an ICH, but 31% would readily operate on haematomas with volumes of between 50 and 80 ml. Over 30% felt that there was no optimal time for surgical evacuation, but 66.9% felt delayed evacuation was helpful. 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. Furthermore, respondents demonstrated a significant tendency to intervene surgically more readily in ICH related to aneurysm or AVM. Results from a prospective randomized controlled trial to assess the role of surgery are urgently needed.