Spontaneous intracerebral supratentorial hemorrhage: general aspects and updates in surgical treatment

Abstract

Background: Spontaneous intracerebral hemorrhage (SIH) accounts for 9 to 25% of all strokes and is associated with a high morbidity and mortality, with less than 40% of affected persons surviving 1 year. The condition commonly presents a sudden onset of focal neurological deficits with accompanying headache, nausea, vomiting, elevated blood pressure and altered consciousness. Medical treatment commonly includes airway support, blood pressure control, management of cerebral edema, symptomatic therapy such as anticonvulsive medication, anticoagulation reversal etc. Different surgical options such as open craniotomy, stereotactic aspiration, endoscopic evacuations with or without thrombolysis have also been considered. Most of these techniques have already been implemented successfully in the Republic of Moldova. According to the data of the Institute of Neurology and Neurosurgery and the Institute of Emergency Medicine for the period 2011-2014, just within these two institutions were performed 137 neurosurgical interventions, including 67 interventions involving minimally invasive techniques with local fibrilolysis and 70 interventions involving other minimally invasive surgery or conventional craniotomy. The obtained results are in concordance with those reported by other European institutions. Conclusions: The continuous efforts to improve the outcome of SIH during the recent years have led to the development of a variety of minimally invasive techniques, most of which have already been adopted by the autochthonous surgeons. New randomized controlled trials are required to establish the suitability of these techniques for different clinical situations and SIH localizations.