What is the role of surgery for most patients with spontaneous ICH?
The role of surgery for most patients with spontaneous ICH remains controversial. The theoretical rationale for hematoma evacuation revolves around the concepts of preventing herniation, reducing ICP, and decreasing the pathophysiological impact of the hematoma on surrounding tissue by decreasing mass effect or the cellular toxicity of blood products. Randomized trials comparing surgery to conservative management have not demonstrated a clear benefit for surgical intervention.