Spontaneous brain haemorrhage affects 20 in 100,000 people every year and studies have suggested the death rate is around 40%. It causes 20% of stroke cases and most survivors are left disabled. There are two treatment options, surgery or medical treatment.

In the International Surgical Trial in Intracerebral Haemorrhage (STICH) David Mendelow (University of Newcastle Upon Tyne, UK) and colleagues assessed whether the early surgery could reduce deaths and disability from brain haemorrhage when compared with initial conservative treatment.

Over 1000 patients with brain haemorrhage, with an average age of 62 years, were recruited from 83 centres in 27 different countries from January 1998 to February 2003. 503 patients were randomised to receive early surgery and 530 to initial conservative treatment. Patients randomised to conservative treatment were given the best available medical treatment. In the conservative treatment arm, 140 patients had neurological deterioration and underwent surgery.

The investigators found that 26% of patients who received early surgery had a favourable outcome at 6 months compared with 24% allocated to initial conservative treatment. The mortality rate for the early surgery group was 36% compared with 37% for initial conservative treatment. Survival during the first six months did not differ between the two groups.

The authors conclude that early surgery is no better than initial conservative treatment for patients with brain haemorrhage. Only patients with blood clots of 1cm or less from the brain surface had a better outcome from early surgery.

Professor Mendelow comments: "There is insufficient evidence to justify a general policy of early operative interventions in patients with spontaneous brain haemorrhage, compar
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Contact: Joe Santangelo
j.santangelo@elsevier.com
1-212-633-3810
Lancet
27-Jan-2005