title: Haemorrhage and hemicraniectomy: refining surgery for stroke.
abstract: OBJECTIVE
  Intracerebral haemorrhage is a devastating cerebrovascular disease with no established treatment. Its course is often complicated by secondary haematoma expansion and perihemorrhagic oedema. Decompressive hemicraniectomy is effective in the treatment of space-occupying hemispheric ischaemic stroke. The purpose of this review is to assess the role of decompressive hemicraniectomy in intracerebral haemorrhage.
  
  
  RESULTS
  After few small previous studies had suggested advantages by the combination of decompressive hemicraniectomy with haematoma removal, decompression on its own has been investigated within the last 5 years. Two case series and one case-control study in altogether 40 patients with severe spontaneous intracerebral haemorrhage have shown mortality rates ranging from 13 to 25% and favourable outcome from 40 to 65%.
  
  
  CONCLUSIONS
  Decompressive hemicraniectomy appears to be a feasible and relatively well tolerated individual treatment option for selected patients with spontaneous intracerebral haemorrhage. Data are insufficient to judge potential benefits in outcome. A randomized trial is justified and mandatory.
authors.affiliation: aDepartment of Neurology bDepartment of Neurosurgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Julian
authors.initials: J
authors.lastname: Bösel
authors.forename: Klaus
authors.initials: K
authors.lastname: Zweckberger
authors.forename: Werner
authors.initials: W
authors.lastname: Hacke
mesh_terms: D002543:Cerebral Hemorrhage / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000379:methods*; D006801:Humans; D020521:Stroke / Q000601:surgery*