The benefit of surgical hematoma evacuation is not well established for the management of spontaneous intracerebral hemorrhage (ICH). Surgical hematoma drainage has many theoretical benefits, but mixed data regarding its clinical benefit has led to controversy. More recently, investigators have been looking into minimally invasive techniques and how they perform in comparison to conventional craniotomy or medical therapy. Again, studies have been mixed and the effectiveness of minimally invasive surgery remains uncertain. Insufficient high-quality data as well as heterogeneity in study design and ICH definitions has led to many questions remaining unanswered: the ideal candidate and optimal timing of surgery are key examples. Shahid Nimjee, MD, PhD, The Ohio State College of Medicine, Columbus, OH, shares his thoughts on which patients have most to gain from surgical ICH treatment. Many clinicians believe that surgery has the most potential in patients with a large hemorrhage with a significant neurological deficit. Given the potential complications and paucity of definitive supporting evidence, surgery is not recommended when patients have minimal deficits. This interview took place at the World Stroke Congress 2022 in Singapore.
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