Intracerebral haemorrhage: surgical therapy vs. patient-adapted treatment concept

In spontaneous intracerebral haemorrhage (SICH), the indication for surgery is still controversial. Therefore we developed clinical guidelines for therapy and compared the outcome of these patients to an exclusively surgically treated group. We retrospectively evaluated outcome in 70 patients with SICH, who were treated only surgically and compared this group with 58 prospectively collected patients, who were treated surgically (n=13) or medically (n=45). Initial level of consciousness, haematoma volume, and ventricular extension of blood were inversely correlated with mortality (p<0.0001, respectively). Use of clinical guidelines reduced the number of operations without affecting the outcome. We can formulate the following guidelines according to our data: comatose patients with and without brain herniation signs should be treated conservatively. Patients with a haematoma volume between 25 and 85 ml and a clinical deterioration are candidates for surgical therapy.