Rabinstein Alejandro A, Wijdicks Eelco F M
Division of Neurological/Neurosurgical Intensive Care Unit, Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Rev Neurol Dis. 2006 Fall;3(4):163-72.
The value of surgery for patients with intracerebral hemorrhage (ICH) remains a topic of debate. Although several studies have been unable to prove the benefit of surgical intervention of ICH, there is available evidence to suggest that some patients may experience favorable outcome with surgery. Identifying optimal candidates and the timing of surgery for the treatment of ICH are crucial issues. Studies have explored the value of early and ultra-early surgical intervention, as well as the role of stereotactic hematoma evacuation. The International Surgical Trial in Intracerebral Hemorrhage suggested that favorable surgical outcome was more likely for patients with superficial hematomas, and patients who underwent craniotomy in the trial seemed to fare better than those treated with other surgical techniques. A retrospective study of patients with brain tissue shift has provided evidence that surgery may benefit some deteriorating patients; treatment decisions in this patient population should be based on case-by-case assessments of the likelihood of recovery after evacuation. It is critical that therapeutic alternatives for patients with ICH continue to be explored.
脑出血（ICH）患者手术治疗的价值仍是一个有争议的话题。尽管多项研究未能证明脑出血手术干预的益处，但有证据表明部分患者手术可能会有良好预后。确定脑出血治疗的最佳候选患者及手术时机是关键问题。研究探讨了早期和超早期手术干预的价值以及立体定向血肿清除术的作用。国际脑出血外科试验表明，表浅血肿患者手术预后更佳，且该试验中接受开颅手术的患者似乎比接受其他手术技术治疗的患者预后更好。一项对脑组织移位患者的回顾性研究表明，手术可能使一些病情恶化的患者受益；对于这类患者的治疗决策应基于对血肿清除术后恢复可能性的逐例评估。继续探索脑出血患者的治疗选择至关重要。
