Medical versus Surgical Treatment in Acute Intracerebral Hemorrhage: A Propensity-Matched Analysis

The management of acute intracerebral hemorrhage (ICH) primarily involves medical treatment and surgical intervention. However, current evidence regarding the effectiveness and safety of surgical treatment remains controversial. Thus, we conducted a real-world investigation, aimed to explore the actual situation of spontaneous ICH patients receiving different treatment and compare the impact on the prognosis.

The study consecutively collected spontaneous supratentorial ICH patients aged 18 to 80 years within 72 hours of symptom onset from 2019 to 2022. Propensity score matching was employed to ensure the comparability of baseline characteristics, and a subgroup analysis was performed according to hematoma volume. The primary outcome was defined as 3-month functional status.

A total of 568 patients met the inclusion criteria. Of these, 401 received conservative medical treatment, while 167 underwent surgical intervention. After propensity score matching, 76 patients were included in each group. The surgical group demonstrated a reduced mortality rate (P = 0.047) but had a lower incidence of achieving functional independence (P = 0.006) and higher incidence of moderate disability (P = 0.047). Subgroup analysis revealed that minimally invasive surgical treatment was associated with a decreased mortality in patients with hematomas of 30-100 mL.

While surgical intervention can reduce mortality, it may have a negative impact on functional independence. Minimally invasive surgical treatment for patients with large-size hematoma (30-100 mL) may be beneficial. Personalized treatment strategies are essential to identify patients who may benefit most from surgical intervention.