title: Comparison of spontaneous intracerebral hemorrhage treatment in Germany between 1999 and 2009: results of a survey.
abstract: OBJECTIVE
  The aim of our study was to examine surgical practice in the therapy of spontaneous intracerebral hemorrhage in Germany over a period of 10 years.
  
  
  METHODS
  In 1999 and 2009 a questionnaire with 10 different cases of spontaneous intracerebral hemorrhage was sent to all neurosurgical centers in Germany. It included a cranial CT as well as a case description. The question asked if a conservative or surgical procedure was most suitable. When choosing surgery, the participants could decide between large open approach or microsurgery as well as stereotactic aspiration or external ventricular drainage.
  
  
  RESULTS
  In 1999, 85 of 121 (70%) and in 2009 111 of 125 (89%) questionnaires could be evaluated. The results of the questionnaires from 1999 and 2009 showed no difference in the decision for or against a surgical procedure, except for a move toward conservative treatment in 1 patient with a massive spontaneous intracerebral hemorrhage. In 2 cases of isolated basal ganglia bleeding, a conservative approach was chosen by approximately 98% of the participants both in 1999 and in 2009. In all other cases of spontaneous intracerebral hemorrhage, in particular when the patient was in poor clinical condition, the decision was very heterogeneous.
  
  
  CONCLUSIONS
  Despite new studies, there were no significant differences regarding the decision for or against a surgical procedure in 1999 and 2009. Although clearly unfavorable prognostic factors are known, many patients still undergo a surgical procedure. It appears that at least spontaneous intracerebral hemorrhage in the area of the basal ganglia is a unique domain of conservative treatment.
authors.affiliation: Department of Neurology, Neuro-Intensive Care Unit, Klinikum Kassel, Mönchebergstraße 41-43, 34125 Kassel, Germany. roth99@web.de
authors.forename: Christian
authors.initials: C
authors.lastname: Roth
authors.forename: Stefanie
authors.initials: S
authors.lastname: Kästner
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Salehi
authors.forename: Jens
authors.initials: J
authors.lastname: Kleffmann
authors.forename: Dieter-Karsten
authors.initials: DK
authors.lastname: Böker
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Deinsberger
mesh_terms: D000328:Adult; D000368:Aged; D020145:Basal Ganglia Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy*; D004322:Drainage; D005260:Female; D005858:Germany; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000706:statistics & numerical data / Q000639:trends; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data* / Q000639:trends*; D011379:Prognosis; D013238:Stereotaxic Techniques / Q000706:statistics & numerical data / Q000639:trends; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome