Strategy, technology, and techniques of surgical treatment of supratentorial intracerebral hematomas

The present study targets the problem of the surgical approach to treatment of intracranial hematomas. We examined a total of 242 patients with clinically evident spontaneous nontraumatic intracerebral hematomas. The majority of patients (79%) were treated in the acute phase of stroke. The patients underwent one of the following treatments: (a) In 731 patients, the hematomas were removed following craniotomy and cortiectomy performed under direct visualization, with a mortality rate of 42.5%; (b) in 64 patients, the hematomas were evacuated stereotactically, with a mortality rate of 21.9%; (c) in four patients, only ventricular drainage was used; and (d) 101 patients were treated with routine nonsurgical methods (comprising the pharmaceutical or conservative group), with a mortality rate of 49.5%. The overall mortality rate was 40%. In 43 patients, a special balloon was implanted into the hematoma cavity after evacuation to prevent recurrent bleeding. Although the first part of this work is now finished, further study of the dynamics of hemorrhage and additional results are needed prior to making a decision on how to divide patient management into the two categories of surgical and nonsurgical treatment.