Surgical Treatment of ICH

• Does open craniotomy with evacuation of supratentorial ICH improve patient outcome?
  
• Does endoscopic aspiration for supratentorial ICH improve patient outcome?
  
• Does surgical evacuation of cerebellar ICH benefit patients?
  
• Does ventriculostomy for hydrocephalus improve patient outcome?

---

Open Craniotomy with Evacuation of Supratentorial ICH:
Randomized Control Trials

Study One
McKissock W, Richardson A, Taylor J. Primary intracerebral hemorrhage: A controlled trial of surgical and conservative treatment in 180 unselected cases. Lancet. 1961; 2: 221-226.

• Inclusion Criteria: Patients with clinical history, physical signs, CSF, and angiography supporting the diagnosis of supratentorial ICH were randomized to either conservative management or surgery. No time limit specified.
  • 91 patients randomized to conservative management
  • 89 patients randomized to surgery.
• Treatment was craniotomy and evacuation of the hematoma.
• Outcome was mortality and disability at 6 months.

Results:

	Surgery	Medical
Mortality	65%	51%
Bad Outcome	80%	66%

Odds Ratio of Death and Dependency:
(95% CI) 2.00 (1.04-3.86) medical better

---

Study Two
Juvela S, Heiskanen O, Poranen A, et al. The treatment of spontaneous intracerebral hemorrhage: a prospective randomized trial of surgical and conservative treatment. J. Neurosurg. 1989; 70: 755-758.

• Inclusion Criteria: Patient with CT confirmed supratentorial ICH who were admitted within 24 hours of the onset. Patient were either unconscious or had severe hemiparesis. Surgery within 48 hours.
  • 26 in conservative management
  • 26 in surgical group
• Treatment: Craniotomy with evacuation of hematoma
• Outcome: Death or disability (Glasgow Outcome Scale) at 6 months and 12 months.

Results:

	Surgery	Medical
Mortality	46%	38%
Bad Outcome	98%	81%

Odds Ratio of Death and Dependency:
4.39 (0.81-23.65) medical better

---

Study Three
Batjer HH, Reisch JS, Allen BC, et al. Failure of surgery to improve outcome in hypertensive putaminal hemorrhage: a prospective randomized trial. Arch Neurol. 1990; 47: 1103-1106.

• Inclusion Criteria: 21 patients with CT confirmed putaminal ICH > 3 cm and with hypertensive history who had altered consciousness or limb weakness.
  • 9 patients in best medical management
  • 4 patients with medical management and ICP monitoring
  • 8 patients with surgical evacuation
• Treatment: Craniotomy with evacuation of hematoma
• Outcome: Mortality and functional outcome at 3 and 6 months.

Results:

	Surgery	Medical
Mortality	78%	67%
Bad Outcome	78%	83%

Odds Ratio of Death and Dependency:
0.86 (0.10-7.64) surgery better

---

Study Four
Morgenstern LB, Frankowski RF, Shedden P, et al. Surgical treatment for intracerebral hemorrhage (STICH): a single-center, randomized clinical trial. Neurology. 1998; 51: 1359-1363.

• Inclusion Criteria: Patients with CT confirmed supratentorial (lobar or extending out o thalamus) ICH > 9 cc, GCS 5-15 within 12 hours of onset
  • 15 patients in surgical group
  • 16 patients in medical group
• Treatment: Craniotomy with evacuation of hematoma
• Outcome: Mortality or disability at 1 month and 6 month.

Results:

	Surgery	Medical
Mortality	24%	18%
Bad Outcome	50%	69%

Odds Ratio of Death and Dependency:
0.46 (0.11 to 1.86) surgery better

---

Study Five
Zuccarello M, Brott T, Derex L, et al. Early surgical treatment for supratentorial intracerebral hemorrhage: a randomized feasibility study. Stroke. 1999; 30: 1833-1839.

• Inclusion Criteria: Patients with CT confirmed ICH > 10 cc, within 24 hours of onset, GCS > 4, and associated neurological deficits.
  • 9 patients in surgical group
  • 11 in conservative management group
• Treatment: Craniotomy/stereotactic aspiration.

Results:

	Surgery	Medical
Mortality	22%	27%
Bad Outcome	44%	64%

Odds Ratio of Death and Dependency:
0.48 (0.09 to 2.69) surgery better

 

Back

Next

The content of these pages was written by Dr. Aninda Acharya of St.Louis University.

Last Revised: August 31, 2002