Principles and Techniques of Surgical Management of ICH
Intracerebral hemorrhage (ICH) is one of the most common classes of stroke. Indications for surgery in patients with ICH are largely dependent on patient age, level of consciousness, time elapsed since ICH onset, and the site and size of hemorrhage; however, research in ICH approach, management, surgical indications, and technical management have not completely addressed some of the most common complications of this condition. In this chapter we review the efficacy of craniotomy and hematoma evacuation in various presentations following ICH. We also discuss current guidelines by which endoscopic evacuation can be considered, conclusions from a number of trials involving stereotactic catheter aspiration with fibrinolytic agents, and the use of decompressive craniectomy. We conclude that the standard of care should continue to be refined as new evidence becomes available, specifically that which is concerned with hemorrhage type and location.
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