Stroke is an important health issue in the United States. More than 700,000 strokes occur per year in the United States, making it the third leading cause of death (1,2). Spontaneous supratentorial intracerebral hemorrhage (ICH) accounts for 20% of all stroke-related sudden neurologic deficits (3) and carries a particularly poor prognosis, with more than one-third of patients dying within 1 month after onset of symptoms and only 20% regaining functional independence (4). The appropriate roles of medical and surgical ICH treatment remain controversial. Medical treatment is largely supportive and often necessitates intensive care. Emerging data has shown that lowering of blood pressure might prevent additional hemorrhage (5) and that recombinant activated factor VII is a promising new therapy that can limit hematoma enlargement and, consequently, reduce morbidity and mortality (5,6). Cerebral edema following an ICH might be another target for medical therapy in this dynamic process. Although, overall, the surgical evacuation of an ICH has not been shown to improve patient outcome, certain patient group subsets might benefit from this procedure. This chapter will discuss surgical management and related factors.

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