Surgery of Hypertensive Intracerebral Hematomas

Objective: Hypertensive intracerebral hematoma is a neurosurgical emergency that has a high mortality and morbidity. Common locations include putaminal, thalamic, cerebellar, and pontine. The aim of this study is to identify easily applicable guidelines for surgical and nonsurgical treatment. Methods: Seventy-seven cases with hypertensive intracerebral hematomas were evaluated clinically and using imaging studies. Data were analyzed and parameters suggestive of therapeutic modality were identified. Results: Patients with hypertensive intracerebral hematomas presented with minor stroke in 19.5%, moderate stroke in 58.5%, and major stroke in 22% of all patients. According to their morphology, hematomas were focal in 14%, regional in 26%, ruptured in 22%, dissecting in 28%, and massive in 10% of all patients. For selected patients, surgical evacuation of putaminal hematomas was performed for 53% of patients and conservative management was applied for 47% of patients. For selected patients, surgical evacuation of cerebellar hematomas was performed for 71.4% of cases and conservative management for 28.6% of cases. Conclusions: Therapeutic decision for hypertensive intracerebral hematomas depends on admission Glasgow coma scale and morphology of the hematoma on computed tomography.