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Primary intracerebral hemorrhage (ICH) is associated with a high mortality rate and severe morbidity. The treatment of choice is still controversial, given that data from several clinical trials have not provided convincing evidence to support the efficacy of surgical clot removal. Favoring early clot removal is evidence that the limited release of specific neurotoxins associated with the breakdown products of hemoglobin underlies secondary brain injury. Attention has therefore shifted to perilesional brain injury, especially brain edema, as a potential target for therapeutic intervention in patients with ICH. In this review the authors address current understanding of the causes of edema formation following ICH and the treatment options, which are mostly supportive in nature.
Despite major advances in early diagnosis, improvements in neurosurgical critical care, and refinements in microsurgical techniques, the efficacy of surgical treatment for primary ICH is still controversial, as shown in the most recent prospective, randomized, multicenter clinical trial. The major goal of surgical treatment in patients with ICH is safe and thorough clot evacuation, with maximal preservation of neurological function. Note, however, that even less invasive approaches for hema to ma puncture by using stereotactic procedures or endos copy to minimize trauma to overlying normal brain tissue do not provide a better functional outcome.
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