Review articleRole of surgery in the management of patients with supratentorial spontaneous intracerebral hematoma: Critical appraisal of evidence

•Role of surgery in spontaneous intracerebral hematoma is controversial.•There is insufficient evidence to justify early surgery.•STITCH did demonstrate possible benefit from craniotomy in superficial hematoma patients.

BackgroundWhether surgery improves the outcome more than medical management alone continues to be a subject of intense debate and controversy. However, there is optimism that the management of spontaneous supratentorial intracerebral haemorrhage will change in future based new insight and better understanding of the acute pathophysiology of hematomas and its dynamics. Craniotomy as a surgical approach has been the most studied intervention for spontaneous supratentorial intracerebral haemorrhage but with no significant benefit when compared to best medical management.MethodA literature search was conducted using electronic data bases including the Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane library, MEDLINE and EMBASE. In addition, critical appraisal of most current evidences was carried out.ResultAbout 1387 articles identified through database search over 10-year period of which one systematic review and two randomised controlled trials most relevant to this review were critically appraised.ConclusionThe role of surgery in the management of spontaneous intracerebral haemorrhage still remains a matter of debate. There is insufficient evidence to justify a general policy of early surgery for patients with spontaneous intracerebral haemorrhage compared to initial medical management but STICH did demonstrate that patients with superficial hematoma might benefit from craniotomy.