Treatment for Supra-tentorial Intracerebral Hemorrhage.

Only vague guidelines exist for the surgical management of intracerebral hemorrhage (ICH). We investigated the indications for surgical management of intracerebral hemorrhage and compared the outcomes of computed tomography (CT)-guided stereotactic hematoma aspiration with those after hematoma removal under craniotomy.Our indications for CT-guided stereotactic hematoma aspiration were an age < 80 years old, a hematoma volume ≥ 10 ml, and a Glasgow Coma Scale (GCS) score ≤ 14. Those for hematoma removal under craniotomy were a hematoma that was large enough to be life-threatening and/or lobular, suggesting underlying vascular lesions. Patients with bilateral pupillary dilatation and cases of hematoma extending to the brain stem were excluded. In 131 cases of ICH, hematoma volume, total cost of hospitalization, initial GCS score, age, activity of daily living (ADL) at discharge, and final ADL, were selected for analysis.In patients with an initial GCS score between 8 and 14, only slight improvement in ADL was found after CT-guided stereotactic hematoma aspiration compared with conservative management. The total cost and the duration of hospitalization were lower and shorter in conservatively managed cases than in cases treated with stereotactic surgery. In patients with an initial GCS score ≤ 9, the total cost was higher for craniotomy cases than for stereotactic cases, however, the ADL at discharge was higher.CT-guided stereotactic hematoma aspiration has limited benefit for patients with ICH and is contraindicated for patients with an initial GCS score ≤ 9, who should be managed by craniotomy.