Early surgical treatment not always necessary for patients with brain h...( ed with initial conservative treatment....),Health

In an accompanying commentary Takahiro Nakano (Hirosaki University School of Medicine, Japan) does not believe the result directly challenges the usefulness of surgery for brain haemorrhage because 26% of patients randomised to initial conservative treatment needed surgery a few days after randomisation.

Dr Nakano concludes: "Besides appropriate selection of subgroups of patients for surgery, it is important to improve operative techniques to obtain good surgical results. The results of STICH show that there is more likely to be a favourable outcome of surgery, mainly craniotomy, if the haematoma [blood clot] is 1 cm or less from the cortical [brain] surface. The reason is that if the blood clot is near the cortical [brain] surface, surgical destruction of brain tissue in reaching the haematoma [clot] is minimal. For deep haematomas [blood clots], benefits will be obtained if a less invasive, safe, and effective method of clot evacuation exists. Endoscopic surgery is one of the methods expected to be effective for treatment of deep haematoma [blood clot]."

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Contact: Joe Santangelo
j.santangelo@elsevier.com
1-212-633-3810
Lancet
27-Jan-2005