Surgery for infratentorial primary intracerebral haemorrhage

Although there is general agreement that surgical intervention in this situation may be life saving (so much so that a randomised controlled trial is unlikely ever to be done), there is considerable uncertainty about which patients might benefit the most or even which procedure is optimal (haematoma evacuation versus ventricular decompression via a ventriculostomy, or both). We would always consider surgical intervention in any patient who was comatose or whose conscious level was progressively deteriorating and in whom other exacerbating causes had been excluded (Box 3.2). Once brain stem reflexes have been absent for several hours, however, death is inevitable.98

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