Based on current study results, surgery is no longer generally recommended (exception: cerebellar hemorrhage)!
Whether surgical intervention is reasonable and promising depends on several factors:
- Age of the patient
- Extent/size of bleeding (bleeding volume).
- Concomitant diseases
- Cause of bleeding
- Clinical condition of the patient
- Localization of the bleeding
- Incursion of the hemorrhage into the ventricular system (cavity system in the brain) (intraventricular hemorrhage (IVB)).
Indications for hematoma evacuation
- Major bleeding and younger patient
- Pronounced symptomatology
- Secondary clinical deterioration
- Intraventricular hemorrhage (IVB).
- Cerebellar intracerebral hemorrhage with a diameter > 3 (to 4) cm or a hematoma volume > 7 ml
Depending on the location of the intracerebral hemorrhage and after review of the previously described criteria, the following approaches may be considered:
- Supratentorial localization in the cerebral region (thalamic and brainstem hemorrhages).
- Hematomevacuation (clearance of hematoma) via craniotomy (trepanation = opening of the skull)
- Indications: the patient’s level of consciousness deteriorates rapidly and the hemorrhage is superficial
- Disadvantage: craniotomy represents a procedure with high invasiveness. Therefore, minimally invasive procedures are in clinical trials. In some cases, hematoma evacuation is supplemented by the additional introduction of recombinant tissue-specific plasminogen activator (rtPA). This so-called” intraventricular lysis therapy” accelerates blood resorption and thereby normalizes the circulation of the cerebrospinal fluid (CSF). As a result, mortality (mortality) is reduced.
- Hematomevacuation (clearance of hematoma) via craniotomy (trepanation = opening of the skull)
- Infratentorial localization in the cerebellar region.
For occlusive hydrocephalus
- Installation of an external ventricular drain (EVD) – this allows drainage of cerebrospinal fluid from the ventricular system (cavity system) of the brain.
