Surgical treatment of hypertensive intracerebral hemorrhage

Abstract

Hypertensive intracerebral hemorrhage (ICH) is a disease with high morbidity, disability rate and mortality. Compared with conservative treatment, the effectiveness of surgery is still controversial. However, surgery is the most promising treatment to improve prognosis of hypertensive ICH. There are currently three main surgical methods. Craniotomy removes the hematoma under microscope and can achieve reliable hemostasis. Limited by large trauma, relatively long operation time and massive bleeding in operation, the neurological function recovery of patients treated by this procedure is not ideal. Hematoma puncture and catheter drainage brings least injury to normal brain tissue. Nevertheless, the neurosurgeon is unaware of the intracranial situation when operating, and urokinase injection may increase the risk of intracranial infection. Endoscopic hematoma evacuation can completely remove the hematoma, which is less invasive and may avoid damage to nerve fiber bundle. Prospective studies investigating the efficacies of these three surgical approaches are lacking, while the Minimally-Invasive Surgery versus Craniotomy in Patients with Supratentorial Hypertensive Intracerebral Hemorrhage (MISICH) study is expected to provide better data and evidence.

DOI: 10.3969/j.issn.1672-6731.2018.12.001