An update on the Acute Surgical Management of Intracerebral Haemorrhage

Whether surgical intervention benefits patients or patient subgroups with intracerebral haemorrhage (ICH) remains controversial, despite numerous randomised controlled trials. However, ICH without intervention has an extremely high mortality rate, with significant disability in many survivors. Consequently, there is a wide variety of practices worldwide, from near-routine intervention in large ICH to near-complete avoidance of surgery. We review the evidence behind ICH surgical intervention, discuss peri-operative management, and also mention ongoing trials of early minimally-invasive surgery, which may strengthen the evidence base in this challenging field.