Spontaneous intracerebral haemorrhage: a surgical dilemma.
The optimal management, surgical or otherwise, of a patient following a spontaneous intracerebral haemorrhage (ICH) remains controversial. A survey of British neurosurgeons was carried out to assess current attitudes and practice. Patient management was most consistently influenced by the depth (71% agreement), dominance (74.3% agreement) and site (44.7%) of the haematoma. Almost half of neurosurgeons said they would evacuate an ICH in a deteriorating patient, but management choice was very varied in stable patients. However, 80% of the same respondents felt evacuation was helpful in reducing mortality, and 71.3% morbidity. Fifteen per cent of respondents were not influenced by the size of an ICH, but 31% would readily operate on haematomas with volumes of between 50 and 80 ml. Over 30% felt that there was no optimal time for surgical evacuation, but 66.9% felt delayed evacuation was helpful. Premorbid dependency was a stronger influence than age on management choice. Despite these variations, over half felt that they were consistent in their treatment of ICH. However, 81% expressed surgical uncertainty. Furthermore, respondents demonstrated a significant tendency to intervene surgically more readily in ICH related to aneurysm or AVM. Results from a prospective randomized controlled trial to assess the role of surgery are urgently needed.
Fernandes
H M
HM
Department of Surgery (Neurosurgery), University of Newcastle-upon-Tyne, UK.
Mendelow
A D
AD
D002543:Cerebral Hemorrhage / Q000601:surgery*; D006406:Hematoma / Q000601:surgery*; D006801:Humans; D008505:Medical Staff, Hospital; D019635:Neurosurgical Procedures / Q000379:methods; D015588:Observer Variation; D005791:Patient Care; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D006113:United Kingdom