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Surgery for spontaneous intracerebral hemorrhage

Lookup NU author(s): Emeritus Professor David Mendelow, Dr Barbara Gregson, Patrick Mitchell


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© Cambridge University Press 2014. Intracerebral hemorrhage (ICH) is not a homogeneous condition and neither is its response to surgical removal. In some situations surgical removal is clearly indicated. Early presentation and hemorrhage in relatively non-eloquent areas that compromise function in other areas via mass effect argue for surgical removal. Post-operative hematomas that inevitably follow about 3% (61/1806) of craniotomies (1) present early and, when significant, are removed. Hematomas that expand while the patient is on the neurosurgical ward are another example of an acute presentation (of expansion) and are commonly removed. Early intervention may save brain in the penumbra of functionally impaired but potentially viable tissue that surrounds the clot immediately following the ictus. Cerebellar hematomas are inclined to cause secondary hydrocephalus which, where significant, is treated. The clot in the cerebellum may compromise brain stem function via mass effect which is also commonly treated by surgical removal. Late presentation and hemorrhages in the thalamus or brain stem argue for non-surgical treatments.

Publication metadata

Author(s): Mendelow AD, Gregson BA, Mitchell P

Publication type: Book Chapter

Publication status: Published

Book Title: Critical Care of the Stroke Patient

Year: 2013

Pages: 320-328

Online publication date: 01/06/2014

Publisher: Cambridge University Press


DOI: 10.1017/CBO9780511659096.031

Library holdings: Search Newcastle University Library for this item

ISBN: 9780511659096