Early elective surgical exploration of spontaneous intracerebral hematomas of unknown origin Clinical article

Object. The management of non-life threatening spontaneous intraparenchymal hemorrhage with no obvious medical etiology in patients and the lack of findings on images has not been clearly defined. In general. the current practice is to treat these patients conservatively and repeat studies to role out a treatable cause 6 weeks to 3 months later: more often than not these repeated studies fail to reveal any findings, and the patient is treated conservatively. For years. the senior author (R.C.H.) has treated these patients with early surgical exploration, This study was under-taken prospectively to ascertain the frequency of positive findings during surgical exploration. Methods. Between 2000 and 2007. the authors prospectively collected data from 9 cases (4 cerebellar, 4 lobar. and 1 caudate head) of unexplained intraparenchymal hemorrhages. The patient age ranged from 19 to 45 years (mean 31.2 years). All patients were normotensive, had no underlying medical problems explaining such a hemorrhage, and failed to exhibit findings oil cerebral angiograms. Magnetic resonance images with contrast showed no abnormal vasculature or enhancement. Eight patients underwent elective surgical exploration in the subacute stage, and urgent decompression of the clot was necessary in 1. Results. In 7 (77.8%,) of the 9 cases, histopathological examination revealed a cause for the hemorrhage (3 cryptic arteriovenous malformations, 3 cavernomas. and 1 neoplasm). A good outcome was achieved in all 8 patients who Underwent elective surgery. Conclusions. The authors recommend elective surgical exploration of intracerebral hematomas of unknown etiology provided that the hematoma is surgically accessible and the patient is relatively young, all(] healthy. Early exploration and resection call provide a cure and eliminate the risk of rebleeding when a vascular lesion is found or guide further treatment in cases of tumor. (DOI: 10.3171.JNS.2008.109.12.1005)