Spontaneous Putaminal Haematoma. Does Post-operative ICU Management Improve Outcome?

Abstract

Surgical management of spontaneous intracerebral haemorrhage remains controversial because its mortality, in the region of 38% -61%, does not differ significantly whether treated conservatively or operatively [5,6]. In the absence of any general agreement, surgical decision-making is at the level of each individual case, based upon the individual neurosurgeon’s background of training and personal experience. The orthodox teaching of strongly considering surgical evacuation of lobar haematoma >30ml, but never of thalamic haemorrhage, is recommended by modern textbooks of neurosurgery [2]. There is no concensus of opinion in spontaneous putaminal haematoma. Most recently published studies failed to demonstrate any benefit in the surgical group [1, 7, 8]. However, in a selected group of patients with putaminal haematoma, surgical evacuation has been shown to improve both mortality and morbidity [4].