Non-traumatic intracranial hemorrhage may present with bleeding into the subarachnoid space (subarachnoid hemorrhage) or bleeding into brain parenchyma itself (intracerebral hematoma), with or without intraventicular extension (intraventricular hemorrhage). Neurological damage caused directly by the hemorrhage (primary brain damage) is usually unalterable at the time of presentation, and thus the surgical management of these patients concentrates on the prevention of secondary brain damage. This secondary damage may be caused by a further hemorrhage or the effects of an intracerebral hematoma. Therefore operative intervention may be necessary to prevent rebleeding, to evacuate clot, or both.

An intracerebral hematoma may be present after intracranial hemorrhage secondary to an intracranial aneurysm or an arteriovenous malformation or following hypertension. Surgical evacuation of the hematoma may be lifesaving and carried out urgently. However, surgery to prevent rebleeding differs depending on the cause. If appropriate and possible, it may be carried out at the same time as clot evacuation, but more often it is performed some days or weeks after the initial hemorrhage.

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