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Spontaneous intracerebral haemorrhage: a surgical dilemma

Lookup NU author(s): Helen Fernandes, Emeritus Professor David Mendelow


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The optimal management, surgical or otherwise, of a patient following a spontaneous intracerebral haemorrhage (ICH) remains controversial. A survey of British neurosurgeons was carried out to assess current attitudes and practice. Patient management was most consistently influenced by the depth (71% agreement), dominance (74.3% agreement) and site (44.7%) of the haematoma. Almost half of neurosurgeons said they would evacuate an ICH in a deteriorating patient, but management choice was very varied in stable patients. However, 80% of the same respondents felt evacuation was helpful in reducing mortality, and 71.3% morbidity. Fifteen per cent of respondents were not influenced by the size of an ICH, but 31% would readily operate on haematomas with volumes of between 50 and 80 mi. Over 30% felt that there was no optimal time for surgical evacuation, but 66.9% felt delayed evacuation was helpful. Premorbid dependency was a stronger influence than age on management choice. Despite these variations, over half felt that they were consistent in their treatment of ICH. However, 81% expressed surgical uncertainty. Furthermore, respondents demonstrated a significant tendency to intervene surgically more readily in ICH related to aneurysm or AVM. Results from a prospective randomized controlled trial to assess the role of surgery are urgently needed.

Publication metadata

Author(s): Mendelow AD; Fernandes HM

Publication type: Article

Publication status: Published

Journal: British Journal of Neurosurgery

Year: 1999

Volume: 13

Issue: 4

Pages: 389-394

Print publication date: 01/08/1999

ISSN (print): 0268-8697

ISSN (electronic): 1360-046X

Publisher: Informa Healthcare


DOI: 10.1080/02688699943501


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