Surgery for primary supratentorial intracerebral haemorrhage

There is considerable international variation in the rate and indications of surgery for primary supratentorial intracerebral haematoma, reflecting the uncertainty about the effects of surgery.

The objective of this review was to assess the effects of surgery plus routine medical management, compared with routine medical management alone, in patients with primary supratentorial intracerebral haematoma.

We searched the Cochrane Stroke Group trials register, Current Opinion in Neurology and Neurosurgery, and Neurosurgical Clinics of North America (1991 to July 1993) and reference lists of articles.

Randomised and quasi-randomised trials of routine medical treatment plus intracranial surgery compared with routine medical treatment, in patients with presumed or confirmed primary supratentorial intracerebral haematoma. Intracranial surgery included craniotomy, stereotactic endoscopic evacuation or stereotactic aspiration.

Two reviewers independently applied the inclusion criteria, assessed trial quality and extracted the data.

Four trials were included. No trial had blinded outcome assessment. Craniotomy and endoscopic evacuation were analysed separately. Craniotomy showed a non-significant trend towards increased odds of death and dependency among survivors (odds ratio 1.99, 99% confidence interval 0.92 to 4. 31). The result was inconclusive in the two trials with patients confirmed as having primary supratentorial intracerebral haematoma by CT. Endoscopic evacuation was not shown to significantly decrease the odds of death and dependency among survivors in one trial involving 100 patients (odds ratio 0.45, 99% confidence interval 0. 15 to 1.33).

There is not enough evidence to evaluate the effect of craniotomy or stereotactic surgery, or endoscopic evacuation in patients with supratentorial intracerebral haematoma.