Intracerebral Haemorrhage

Stereotactic of Evacuation Haemorrhage

Stereotactic aspiration of brain haemorrhage can avoid a major surgery and is known to improve the mortality and enhance recovery…..


Medical management

  • Initial management should be directed at the basics of airway, breathing and circulation.
  • ICU admission and monitoring
  • Frequent neurological examination
  • Management of blood pressure
  • Correction of underlying coagulopathies
  • The routine use of steroids has not been shown to improve outcome
  • Normalization of ICP which involves elevation of the head of bed, CSF drainage, pain medication and sedation, and osmotic therapy
  • Anti-convulsant therapy
  • Control of hyperglycemia

Stereotactic aspiration of intracranial bleed

Stereotactic evacuation of thalamic hematoma has improved survival rates as compared to craniotomy and evacuation.

Mortality following craniotomy was 34% versus 6.8% following stereotactic aspiration


  • Relief of Intracranial hypertension
  • Subtotal evacuation of the clot
  • Avoidance of injury to important structures


  • Volume >15ml. (> 3cm)
  • Site: thalamic, putaminal, lobar
  • Altered level of sensorium
  • Neurological deficit
  • Preferably within 72 hrs.
  • Maximum duration – 4 weeks
  • Surgically poor candidate who cannot tolerate anaesthesia.


  • Use of local anaesthesia
  • Shorter operating time
  • Less damage to surrounding normal brain.
  • Allows complete hematoma removal
  • Provide means for improved haemostasis


  • Deeply comatose
  • Signs of herniation – dilated pupil, decerebration
  • Short life expectancy
  • AVM & Aneurysm