Management of lobar intracerebral hemorrhage: medical or surgical.

Two case histories of left parietal hemorrhage, with CTs, were evaluated by 88 board-certified neurologists and 114 board-certified neurosurgeons. Among the neurologists, 24% would have referred both patients for removal of the hemorrhage, 24% would have referred one of them, and 52% would have referred neither. Among the neurosurgeons, 47% would have operated on both patients, 25% on one of them, and 28% on neither. The lack of consensus probably results from an imperfect understanding of the natural history of these lesions. Controlled studies, or at least large retrospective studies, are needed to clarify this important therapeutic issue.