[Surgical indications in non traumatic intracerebral haemorrhage]

The treatment of non traumatic intra cerebral haemorrhage is one of the therapeutic challenges at the present time. In spite of present day technology and advances in understanding its physiopathology, the prognosis is the same as it was fifteen years ago. We review the surgical treatments used to date and their results, and describe new approaches to investigation so as to try to establish the most suitable surgical indications.

To date six randomised studies have been done to evaluate surgical treatment as compared with conservative treatment of intracerebral haemorrhage. There is no clear evidence that surgical treatment is better than conservative management. Recent investigations in this field consider cerebral blood flow, oedema and the degradation products of blood.

Indications for surgery in intracerebral haemorrhage are: a) cerebral haemorrhage > 3cm, with neurological deterioration or with signs of compression of the brainstem and hydrocephalus due to obstruction of the ventricle; b) haemorrhage associated with an anatomical lesion such as an aneurysm, arteriovenous malformation or angioma cavernosa, when the prognosis of the patient is good and the lesion is surgically accessible; c) a young patient with a moderate or large lobular haemorrhage; d) it is recommended that surgery, when applicable, be undertaken during the first 12 hours after onset of the condition; e) when surgery is used, stereotaxic surgery may lead to better results.