Neurológia pre prax 2/2011

Surgical treatment of spontaneous intracerebral hemorrhage

Surgery offers a powerful solution to intracranial hypertension caused by intracerebral hemorrhage. Hematoma type, size and location are the main criteria for surgical efficacy, while always keeping in mind that surgery may sometimes save life but not improve its quality. Except for some specific situations (e.g. space-occupying cerebellar hemorrhage) no definite recommendations concerning surgery indications for intracerebral hemorrhage exist so far. Randomised controlled trials are still recruiting patients to prove efficacy of surgical treatment of superficially located middle-sized lobar hemorrhage. Besides craniotomy, minimally-invasive approaches are being studied, such as stereotaxy or endoscopy, as well as tissue plasminogen activator (rt-PA) application via ventriculostomy.

Keywords: intracerebral hemorrhage, external ventricular drainage aka ventriculostomy, intracranial hypertension, cerebellar hemorrhage, craniotomy.