AHA, ASA guidelines for the management of spontaneous intracerebral hemorrhage

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AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage (2015) Management of ICH
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

2015 AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

Surgical Treatment of ICH: Recommendations

Class I

"1.Patients with cerebellar hemorrhage who are deteriorating neurologically or who have brainstem compression and/or hydrocephalus from ventricular obstruction should undergo surgical removal of the hemorrhage as soon as possible (Level of Evidence: B)"

Class III (Harm)

"1. Initial treatment of patients with cerebellar hemorrhage who are deteriorating neurologically or who have brainstem compression and/or hydrocephalus from ventricular obstruction is not recommended (Level of Evidence: C)"

Class IIb

"1. For most patients with supratentorial ICH, the usefulness of surgery is not well established (Level of Evidence: A)"

"2. A policy of early hematoma evacuation is not clearly beneficial compared with hematoma evacution when patients deteriorate (Level of Evidence: A)"

"3. Supratentorial hematoma evacuation in deteriorating patients might be considered as a life-saving measure (Level of Evidence: C)"

"4.Decompressive hemicraniectomy (DC) with or without hematoma evacuation might reduce mortality for patients with supratentorial ICH who are in a coma, have large hematomas with significant midline shift, or have elevated ICP refractory to medical management (Level of Evidence: C)"

"5. The effectiveness of minimally invasive clot evacuation with stereotactic or endoscopic aspiration with or without thrombolytic usage is uncertain (Level of Evidence: B)"

References

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