Medical versus surgical therapy for spontaneous intracranial hemorrhage

Nontraumatic intracerebral hemorrhage (ICH) affects approximately 37,000 to 52,400 people per year in the United States and has the highest mortality rate among stroke subtypes. Despite the prevalence and lethality of this disease, there are relatively few randomized clinical trials on which medical and surgical management decisions can be based. For this reason, there is considerable variability in ICH management among physicians worldwide. Recently reported operation rates for spontaneous supratentorial ICH have varied from 3% in Hungary to 90% in Lithuania. Results from a prospective randomized trial reported by McKissock et al in 1961 established the standard for ICH management during the era before CT; hematoma evacuation offered no benefit over medical management. Since then, however, randomized studies, nonrandomized controlled studies, and meta-analyses have yielded conflicting results.