Surgery for supratentorial primary intracerebral haemorrhage

A systematic review of open surgical drainage via a craniotomy concluded that this sort of surgery was positively harmful.97 However, safer surgical techniques are now available, in particular stereotactic aspiration, and the results of ongoing surgical trials are awaited. In a previously fit person with a large lobar intracerebral haemorrhage whose conscious level is falling, we would refer to our neurosurgeons and encourage them to drain the haematoma. In this situation, where one expects the patient to die unless action is taken, the decisions are relatively easy. More difficult are those patients with lesions deep in the hemisphere and those with severe impairments but no reduction in conscious level. These patients we usually manage conservatively or randomise into one of the ongoing trials of surgical treatment (see www.ncl.ac.uk/stich/).

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