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(Stroke. 2003;34:1567.)
© 2003 American Heart Association, Inc.

Controversies in Stroke

Evacuation of Intracerebral Hematoma Is Likely to Be Beneficial

From the Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Osaka, Japan.

Correspondence to Dr Kazuo Minematsu, Cerebrovascular Division, Dept of Medicine, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan. E-mail kminemat@hsp.ncvc.go.jp

Key Words: hematoma • randomized controlled trials

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A new era has begun for acute ischemic stroke since the success of a clinical trial of hyperacute thrombolytic therapy. By contrast, there is yet time before daybreak in the management of acute intracerebral hematoma (ICH). Although many therapeutic options, including surgical evacuation, are described in stroke textbooks and guidelines for patients with acute ICH, nothing has yet been proven in large-scale randomized clinical trials.^1,2 Only a few subgroups of patients with ICH are listed as candidates for surgical treatment. They are patients with large (>3 cm) cerebellar hematoma and young patients with a lobar hematoma who are clinically deteriorating. Patients with small hematoma and with deep coma should not be treated surgically. For all other ICH patients, the best therapeutic option remains unclear.²

In the first and largest controlled trial by McKissock et al,³ no benefit from surgical evacuation was demonstrated in regard to either mortality or morbidity. However, many patients with ICH have been treated surgically since this negative study. For example, more than 7000 patients with ICH per year are estimated to receive surgical treatment for hematoma evacuation in the United States.⁴ The situation is similar in Japan.

In a retrospective, nonrandomized study in Japan, Kanaya and Kuroda⁵ compared the effects of surgical evacuation on mortality and morbidity in 3638 patients with putaminal hemorrhage to those of medical management in 3372. On the basis of the results, they recommended surgical treatment if the hematoma is larger than 30 mL in extent and the level of consciousness is . . . [Full Text of this Article]

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