Surgery in Spontaneous Intracerebral Hemorrhage– A Series Analysis

The medical and or surgical treatment of spontaneous ICH appears to be a matter of controversy. Vascular malformations, aneurysms and drug abuse are causative factors for spontaneous ICH among the young adults while hypertension (most important and prevalent risk factor), tumors, vasculopathy, coagulopathy and cerebral amyloid angiopathy are causes among older adults. Most of the studies show no significant difference between intense medical therapy or surgery. A prospective analysis was done of patients who underwent surgical intervention for spontaneous ICH. The indications for surgery were a spontaneous ICH confirmed by CT scan, Glasgow Coma Scale (GCS) >4 and volume of clot > 30 cc. Surgical techniques included evacuation by open craniotomy, hemostasis under microscope and adequate decompression (10-15 cm flap removal and duraplasty). Postoperatively, all patients were given multimodality supportive care. A total of 30 patients underwent surgical intervention. They were of age between 7 to 70 years. The causes of lesional haemorrhages were vascular malformation, vasculitis, aneurysm etc. The mortality rate was 40%, much lower than in earlier surgical series, where it is documented as 56% [1,2]. The survival rate among those with lesional hemorrhage (90%) was much higher than those with primary hemorrhage (47%). Lobar hemorrhage was also found to be linked with better survival rates (80%) than the basal ganglia hemorrhage (41.6%). Age also was found to be a prognostic factor. Survival was found to be related inversely with age. Early surgery combined with multimodality medical management has definite positive role in the treatment of patients with spontaneous ICH, especially young patients with lobar and lesional hemorrhage