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This study evaluates the effectiveness of surgical evacuation for improving survival and functional outcomes in spontaneous intracerebral hemorrhage.

April 1, 2026Open Access

Efficacy of surgical evacuation in managing spontaneous supratentorial Intra-Cerebral hemorrhage

Key Points

This study evaluates the effectiveness of surgical evacuation for improving survival and functional outcomes in spontaneous intracerebral hemorrhage.
Prospective cohort study of 25 patients treated for spontaneous ICH at a neurosurgery department
Initial assessments included neurological exams, CT scans, and blood tests
All patients underwent surgical evacuation of hematomas within 24 hours of admission
Mean age of patients was 58.36 years with a 72% male predominance
Initial Glasgow Coma Scale improved from 9.04 to 11.56 post-surgery
20% mortality rate with an average survival of 7.5 days
After six months, 4% of patients had no residual symptoms, indicating significant functional improvement

Abstract

Abstract Background Surgical evacuation of a hematoma offers several theoretical advantages, including the prevention of mass effect and subsequent cerebral herniation, the reduction of elevated intracranial pressure, and the mitigation of excitotoxic and neurotoxic effects caused by the accumulation of blood breakdown products. Aim The present study aims to evaluate survival and functional outcomes after surgical evacuation of spontaneous supratentorial intracerebral hemorrhage (ICH) and identify factors affecting prognosis. Patients and methods This prospective cohort study included 25 consecutive patients admitted and treated in neurosurgery department, Zagazig university hospitals with spontaneous ICH within the period (2023–2024). Initial assessments involved general and neurological examinations, CT scans for hematoma evaluation, and blood tests. Inclusion criteria encompassed all operated spontaneous ICH cases from the past 2 years, while exclusions included patients under 18, those with posterior fossa hematomas, traumatic ICH, and those with associated diffuse subarachnoid hemorrhage. All patients underwent surgical evacuation within 24 h of admission. Results The mean age of patients was 58.36 years, with a male predominance (72%). Initial presentations included seizures in 4% of patients and varying levels of consciousness. The average hematoma size was 68.32 ml, with the right parietal lobe being the most affected site. Postoperatively, the mean Glasgow Coma Scale (GCS) improved from 9.04 to 11.56. Mortality rate was 20%, with an average survival time of 7.5 days for deceased patients. After six months, functional outcomes assessed via the Modified Rankin Scale (mRS) showed significant improvement, with 4% of patients having no residual symptoms. Conclusion Craniotomy and evacuation of spontaneous supratentorial ICH in patients with moderate to good GCS, even with larger hematomas, can lead to favorable long-term functional outcomes. A combination of surgical intervention and neurocritical care is effective, regardless of hematoma size or location.

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