Purpose of review: Controversy still exists about the management of spontaneous intracerebral haemorrhage. This review summarizes our current knowledge on indications and benefits of surgery for intracerebral haemorrhage. It further describes the detailed meta-analysis of the surgical results in lobar (superficial) supratentorial intracerebral haemorrhage, summarizes the limited information on the surgical treatment of cerebellar intracerebral haemorrhage, and identifies three ongoing trials.
Recent findings: A meta-analysis of 12 prospective randomized controlled trials of neurosurgical intervention in spontaneous intracerebral haemorrhage shows a strong trend to reduced mortality (0.85; 95% confidence interval 0.71-1.02). There is an apparent significant benefit from surgery in the three trials in which lobar intracerebral haemorrhage was identified in relation to both death and disability (0.58; 95% confidence interval 0.36 - 0.92). No surgical trial data are available for spontaneous cerebellar intracerebral haemorrhage or for any type of traumatic intracranial haemorrhage. Three trials are ongoing to resolve existing uncertainties.
Summary: Clinicians are encouraged to discover if the suspected beneficial role of surgery truly exists by randomizing patients with intracerebral haemorrhage in the ongoing prospective randomized controlled trials in the following circumstances: lobar intracerebral haemorrhage (clot reaches to within 1 cm of the cortical surface), STICH II; intraventricular haemorrhage (clot maximum size of 30 ml), CLEAR IVH; deep intracerebral haemorrhage and minimal invasive surgery, MISTIE.