gms | German Medical Science

Objective: In recent years several studies regarding the role of surgery in treatment of spontaneous supratentorial intracerebral hematomas (sICH), including a large prospective randomized trial (STICH) were published. To investigate the impact of this research on clinical decision making regarding indications for surgical treatment a survey done in 1999 was repeated in 2009.

Methods: A questionnaire consisting of 10 different sICH cases was sent to all neurosurgical departments in Germany in 1999 and 2009, respectively. Each “case” consisted of a short case history and a CT-scan. A decision between surgical and conservative treatment was required. In case of a decision in favor of surgical treatment the kind of procedure (open surgery, microsurgery, stereotactic surgery, fibrinolytic treatment, CSF drainage) was asked for.

Results: In 1999 68% (n=85) and in 2009 89% (n=111) of the questionnaires were available for statistical evaluation. There was no significant difference in clinical decision making between 1999 and 2009 in any of the cases. Small deep seated hematomas, especially in old, multimorbid patients are a domain of conservative treatment. In all other cases the decisions varied widely. In cases of massive intracerebral hematomas no treatment at all is advised by almost 20%, on the other hand 20% decide for emergency hematoma evacuation although prognosis is poor.

Conclusions: Opinions about indications for surgical treatment are very diverse within the neurosurgical community allover Germany. Despite recently published trials on surgical treatment of sICH the decision for or against surgery did not change within this decade. Current literature had no impact on daily neurosurgical practice.