Management of spontaneous intracerebral hemorrhage: a retrospective comparison of four treatment strategies.

BACKGROUND

Spontaneous intracerebral hemorrhage (ICH) is a severe neurological emergency with high morbidity and mortality. Optimal management remains debated.

METHODS

We retrospectively included consecutive patients with spontaneous ICH at Reims University Hospital (Jan 2020-Aug 2023). Secondary ICH and incomplete data were excluded. Patients were classified into medical management, surgical evacuation, external ventricular drainage, or surgery plus EVD. Primary outcome was 6-month functional status (mRS 0-3 favorable). Secondary outcomes included mortality, ventilation duration, length of stay, intracranial hypertension, and surgical complications.

RESULTS

Among 289 patients (median age 72 years; 57% male), 253 (87%) received medical management, 15 (5%) EVD, 13 (4.5%) surgery, and 8 (3%) combined treatment. Surgical patients had more severe disease: lower GCS, larger hematomas, anisocoria, and higher ventilation rates. Overall 6-month mortality was 38%, with no significant differences between groups. Poor outcome (mRS >3) occurred in 58%, more frequent in surgical patients. Multivariate analysis identified older age, lower GCS, and larger hematoma volume as independent predictors. Surgery did not improve outcomes even in hematomas ≥30 mL.

CONCLUSION

In this cohort, surgery was reserved for the most severe ICH but did not improve 6-month mortality or functional outcomes. Prognosis depended mainly on baseline severity and hematoma characteristics. Careful patient selection and prospective studies are needed to refine surgical indications in spontaneous ICH.