{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T20:02:17Z","timestamp":1792008137860,"version":"4.4.0"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[1999,9]]},"abstract":"<jats:p>\n            <jats:italic>Background and Purpose<\/jats:italic>\n            \u2014The safety and the effectiveness of the surgical treatment of spontaneous intracerebral hemorrhage (ICH) remain controversial. To investigate the feasibility of urgent surgical evacuation of ICH, we conducted a small, randomized feasibility study of early surgical treatment versus current nonoperative management in patients with spontaneous supratentorial ICH.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Methods<\/jats:italic>\n            \u2014Patients with spontaneous supratentorial ICH who presented to 1 university and 2 community hospitals were randomized to surgical treatment or best medical treatment. Principal eligibility criteria were ICH volume &gt;10 cm\n            <jats:sup>3<\/jats:sup>\n            on baseline CT scan with a focal neurological deficit, Glasgow Coma Scale score &gt;4 at the time of enrollment, randomization and therapy within 24 hours of symptom onset, surgery within 3 hours of randomization, and no evidence for ruptured aneurysm or arteriovenous malformation. The primary end point was the 3-month Glasgow Outcome Scale (GOS). A good outcome was defined as a 3-month GOS score &gt;3.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Results<\/jats:italic>\n            \u2014Twenty patients were randomized over 24 months, 9 to surgical intervention and 11 to medical treatment. The median time from onset of symptoms to presentation at the treating hospitals was 3 hours and 17 minutes, the time from randomization to surgery was 1 hour and 20 minutes, and the time from onset of symptoms to surgery was 8 hours and 35 minutes. The likelihood of a good outcome (primary outcome measure: GOS score &gt;3) for the surgical treatment group (56%) did not differ significantly from the medical treatment group (36%). There was no significant difference in mortality at 3 months. Analysis of the secondary 3-month outcome measures showed a nonsignificant trend toward a better outcome in the surgical treatment group versus the medical treatment group for the median GOS, Barthel Index, and Rankin Scale and a significant difference in the National Institutes of Health Stroke Scale score (4 versus 14;\n            <jats:italic>P<\/jats:italic>\n            =0.04).\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Conclusions<\/jats:italic>\n            \u2014Very early surgical treatment for acute ICH is difficult to achieve but feasible at academic medical centers and community hospitals. The trend toward less 3-month morbidity with surgical intervention in patients with spontaneous supratentorial ICH warrants further investigation of very early clot removal in larger randomized clinical trials.\n          <\/jats:p>","DOI":"10.1161\/01.str.30.9.1833","type":"journal-article","created":{"date-parts":[[2011,6,17]],"date-time":"2011-06-17T20:08:03Z","timestamp":1308341283000},"page":"1833-1839","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":245,"title":["Early Surgical Treatment for Supratentorial Intracerebral Hemorrhage"],"prefix":"10.1161","volume":"30","author":[{"given":"Mario","family":"Zuccarello","sequence":"first","affiliation":[{"name":"From the Departments of Neurosurgery (M.Z., J.T., H. Van L., H-S.Y.), Neurology (L.S., J.B.), Emergency Medicine (R.K., A.P.), Radiology (T.T.), and Environmental Health (J.K.), University of Cincinnati Medical Center (Ohio); Department of Neurology, Mayo Clinic, Jacksonville, Fla (T.B.); and Service de Neurologie, Hopitaux de Lyon, Lyon, France (L.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Brott","sequence":"additional","affiliation":[{"name":"From the Departments of Neurosurgery (M.Z., J.T., H. Van L., H-S.Y.), Neurology (L.S., J.B.), Emergency Medicine (R.K., A.P.), Radiology (T.T.), and Environmental Health (J.K.), University of Cincinnati Medical Center (Ohio); Department of Neurology, Mayo Clinic, Jacksonville, Fla (T.B.); and Service de Neurologie, Hopitaux de Lyon, Lyon, France (L.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Derex","sequence":"additional","affiliation":[{"name":"From the Departments of Neurosurgery (M.Z., J.T., H. Van L., H-S.Y.), Neurology (L.S., J.B.), Emergency Medicine (R.K., A.P.), Radiology (T.T.), and Environmental Health (J.K.), University of Cincinnati Medical Center (Ohio); Department of Neurology, Mayo Clinic, Jacksonville, Fla (T.B.); and Service de Neurologie, Hopitaux de Lyon, Lyon, France (L.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashmi","family":"Kothari","sequence":"additional","affiliation":[{"name":"From the Departments of Neurosurgery (M.Z., J.T., H. Van L., H-S.Y.), Neurology (L.S., J.B.), Emergency Medicine (R.K., A.P.), Radiology (T.T.), and Environmental Health (J.K.), University of Cincinnati Medical Center (Ohio); Department of Neurology, Mayo Clinic, Jacksonville, Fla (T.B.); and Service de Neurologie, Hopitaux de Lyon, Lyon, France (L.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Sauerbeck","sequence":"additional","affiliation":[{"name":"From the Departments of Neurosurgery (M.Z., J.T., H. Van L., H-S.Y.), Neurology (L.S., J.B.), Emergency Medicine (R.K., A.P.), Radiology (T.T.), and Environmental Health (J.K.), University of Cincinnati Medical Center (Ohio); Department of Neurology, Mayo Clinic, Jacksonville, Fla (T.B.); and Service de Neurologie, Hopitaux de Lyon, Lyon, France (L.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Tew","sequence":"additional","affiliation":[{"name":"From the Departments of Neurosurgery (M.Z., J.T., H. Van L., H-S.Y.), Neurology (L.S., J.B.), Emergency Medicine (R.K., A.P.), Radiology (T.T.), and Environmental Health (J.K.), University of Cincinnati Medical Center (Ohio); Department of Neurology, Mayo Clinic, Jacksonville, Fla (T.B.); and Service de Neurologie, Hopitaux de Lyon, Lyon, France (L.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry","family":"Van Loveren","sequence":"additional","affiliation":[{"name":"From the Departments of Neurosurgery (M.Z., J.T., H. Van L., H-S.Y.), Neurology (L.S., J.B.), Emergency Medicine (R.K., A.P.), Radiology (T.T.), and Environmental Health (J.K.), University of Cincinnati Medical Center (Ohio); Department of Neurology, Mayo Clinic, Jacksonville, Fla (T.B.); and Service de Neurologie, Hopitaux de Lyon, Lyon, France (L.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hwa-Shain","family":"Yeh","sequence":"additional","affiliation":[{"name":"From the Departments of Neurosurgery (M.Z., J.T., H. Van L., H-S.Y.), Neurology (L.S., J.B.), Emergency Medicine (R.K., A.P.), Radiology (T.T.), and Environmental Health (J.K.), University of Cincinnati Medical Center (Ohio); Department of Neurology, Mayo Clinic, Jacksonville, Fla (T.B.); and Service de Neurologie, Hopitaux de Lyon, Lyon, France (L.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Tomsick","sequence":"additional","affiliation":[{"name":"From the Departments of Neurosurgery (M.Z., J.T., H. Van L., H-S.Y.), Neurology (L.S., J.B.), Emergency Medicine (R.K., A.P.), Radiology (T.T.), and Environmental Health (J.K.), University of Cincinnati Medical Center (Ohio); Department of Neurology, Mayo Clinic, Jacksonville, Fla (T.B.); and Service de Neurologie, Hopitaux de Lyon, Lyon, France (L.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur","family":"Pancioli","sequence":"additional","affiliation":[{"name":"From the Departments of Neurosurgery (M.Z., J.T., H. Van L., H-S.Y.), Neurology (L.S., J.B.), Emergency Medicine (R.K., A.P.), Radiology (T.T.), and Environmental Health (J.K.), University of Cincinnati Medical Center (Ohio); Department of Neurology, Mayo Clinic, Jacksonville, Fla (T.B.); and Service de Neurologie, Hopitaux de Lyon, Lyon, France (L.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Khoury","sequence":"additional","affiliation":[{"name":"From the Departments of Neurosurgery (M.Z., J.T., H. Van L., H-S.Y.), Neurology (L.S., J.B.), Emergency Medicine (R.K., A.P.), Radiology (T.T.), and Environmental Health (J.K.), University of Cincinnati Medical Center (Ohio); Department of Neurology, Mayo Clinic, Jacksonville, Fla (T.B.); and Service de Neurologie, Hopitaux de Lyon, Lyon, France (L.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Broderick","sequence":"additional","affiliation":[{"name":"From the Departments of Neurosurgery (M.Z., J.T., H. Van L., H-S.Y.), Neurology (L.S., J.B.), Emergency Medicine (R.K., A.P.), Radiology (T.T.), and Environmental Health (J.K.), University of Cincinnati Medical Center (Ohio); Department of Neurology, Mayo Clinic, Jacksonville, Fla (T.B.); and Service de Neurologie, Hopitaux de Lyon, Lyon, France (L.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1993.78.2.0188"},{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.57.8.936"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199203123261103"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1159\/000107814"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.54.7.595"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1989.70.4.0530"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1990.00530100071015"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1989.70.5.0755"},{"key":"e_1_3_2_9_2","first-page":"222","volume":"2","year":"1961","unstructured":"McKissock W, Richardson A, Taylor J. 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