A cerebral haemorrhage is a life-threatening emergency in which there is bleeding into the brain. But not every cerebral hemorrhage needs surgery. On the one hand, the extent of the bleeding, i.e. the amount of blood, is crucial.
Smaller bleedings are spontaneously resorbed, so they dissolve by themselves. Larger ones may have to be removed surgically. On the other hand, the location, i.e. where in the brain the bleeding occurred, is an important criterion. The cause of the bleeding also plays a role in the treatment. If, for example, a bulging blood vessel (aneurysm) has burst, this often has to be treated surgically.
Indication for surgery
Whether a cerebral hemorrhage requires surgery depends on many factors. Firstly, the cause of the bleeding is relevant. For example, is an aneurysm (bulging of a blood vessel) the cause of bleeding?
For another, the location is decisive. A distinction is made here between bleedings that lie above or below the cerebellum. If the hemorrhage is in the cerebrum and the bleeding is not caused by an aneurysm, it is possible to wait and see, unless there are neurological symptoms.
If the patient’s alertness (vigilance) is reduced or worsens in the course of the disease, surgery is recommended. Even a superficial hemorrhage (< 1cm from the brain surface) can be removed easily by surgery without major environmental trauma. In cases of deep-seated bleeding in the cerebrum, patients are much more reluctant to undergo surgery.
If the bleeding is localized near the cerebellum, the following complications may occur: There is only limited space in the bony skull, so the hematoma can press on the brain tissue and damage the nerve cells. There is a particular fear of damage to the brain stem, which can quickly lead to impaired breathing and death. The outflow of nerve water (cerebrospinal fluid) can also be prevented by bleeding near the cerebellum. Therefore, surgery should be performed if imaging shows a congestion of the cerebrospinal fluid. One can also try to drain the liquor to the outside via a tube (external ventricular drainage).
