{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T07:01:36Z","timestamp":1780470096006,"version":"3.54.1"},"reference-count":31,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T00:00:00Z","timestamp":1753833600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Intracerebral hemorrhage (ICH) is a severe form of stroke associated with high morbidity and mortality. While neurosurgical evacuation may offer theoretical benefits, its impact on survival and hospital course remains debated. We aimed to compare the outcomes of surgical versus conservative management in patients with lobar, capsulo-lenticular, and thalamic ICH and to identify factors influencing mortality and the surgical decision. Methods: This single-center, retrospective cohort study included adult patients admitted to the County Clinical Emergency Hospital of Sibiu (2017\u20132023) with spontaneous supratentorial ICH confirmed via CT (deepest affected structure determining lobar, capsulo-lenticular, or thalamic location). We collected data on demographics, clinical presentation (Glasgow Coma Scale [GCS], anticoagulant use), hematoma characteristics (volume, extension), treatment modality (surgical vs. conservative), and in-hospital outcomes (mortality, length of stay). Statistical analyses included t-tests, \u03c72, correlation tests, and logistic regression to identify independent predictors of mortality and surgery. Results: A total of 445 patients were analyzed: 144 lobar, 150 capsulo-lenticular, and 151 thalamic. Surgical intervention was more common in patients with larger volumes and lower GCS. Overall, in-hospital mortality varied by location, reaching 13% in the lobar group, 20.7% in the capsulo-lenticular group, and 35.1% in the thalamic group. Within each location, surgical intervention did not significantly reduce overall in-hospital mortality despite the more severe baseline presentation in surgical patients. In lobar ICH specifically, no clear survival advantage emerged, although surgery may still benefit those most severely compromised. For capsulo-lenticular hematomas &gt; 30 mL, surgery was associated with lower mortality (39.4% vs. 61.5%). In patients with large lobar ICH, surgical intervention was associated with mortality rates similar to those seen in less severe, conservatively managed cohorts. Multivariable adjustment confirmed GCS and hematoma volume as independent mortality predictors; age and volume predicted the likelihood of surgical intervention. Conclusions: Despite targeting more severe cases, neurosurgical evacuation did not uniformly lower in-hospital mortality. In lobar ICH, surgical patients with larger hematomas (~48 mL) and lower GCS (~11.6) had mortality rates (~13%) comparable to less severe, conservative cohorts, indicating that surgical intervention was associated with similar mortality rates despite higher baseline risk. However, these findings do not establish a causal survival benefit and should be interpreted in the context of non-randomized patient selection. For capsulo-lenticular hematomas &gt; 30 mL, surgery was associated with lower observed mortality (39.4% vs. 61.5%). Thalamic ICH remained most lethal, highlighting the difficulty of deep-brain bleeds and frequent ventricular extension. Across locations, hematoma volume and GCS were the primary outcome predictors, indicating the need for timely intervention, better patient selection, and possibly minimally invasive approaches. Future prospective multicenter research is necessary to refine surgical indications and validate these findings. To our knowledge, this investigation represents the largest and most contemporary single-center cohort study of supratentorial intracerebral hemorrhage conducted in Romania.<\/jats:p>","DOI":"10.3390\/jcm14155372","type":"journal-article","created":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T10:55:37Z","timestamp":1753872937000},"page":"5372","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Surgical Versus Conservative Management of Supratentorial ICH: A Single-Center Retrospective Analysis (2017\u20132023)"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9471-4300","authenticated-orcid":false,"given":"Cosmin","family":"Cindea","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania"},{"name":"County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel Bogdan","family":"Todor","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania"},{"name":"County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4997-2690","authenticated-orcid":false,"given":"Vicentiu","family":"Saceleanu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania"},{"name":"County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamas","family":"Kerekes","sequence":"additional","affiliation":[{"name":"County Clinical Emergency Hospital of Brasov, 500097 Brasov, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Tudor","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania"},{"name":"County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corina","family":"Roman-Filip","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania"},{"name":"County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9198-353X","authenticated-orcid":false,"given":"Romeo Gabriel","family":"Mihaila","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania"},{"name":"County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/S1474-4422(09)70340-0","article-title":"Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: A systematic review and meta-analysis","volume":"9","author":"Luitse","year":"2010","journal-title":"Lancet Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1632","DOI":"10.1016\/S0140-6736(09)60371-8","article-title":"Intracerebral haemorrhage","volume":"373","author":"Qureshi","year":"2009","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1016\/S0140-6736(18)31878-6","article-title":"Intracerebral haemorrhage: Current approaches to acute management","volume":"392","author":"Cordonnier","year":"2018","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1161\/STROKEAHA.117.016990","article-title":"Diagnosis of cerebral amyloid angiopathy: Evolution of the Boston criteria","volume":"49","author":"Greenberg","year":"2018","journal-title":"Stroke"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2060","DOI":"10.1161\/01.STR.0000080678.09344.8D","article-title":"Risk factors for intracerebral hemorrhage in the general population: A systematic review","volume":"34","author":"Ariesen","year":"2003","journal-title":"Stroke"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.1161\/STR.0000000000000069","article-title":"Guidelines for the management of spontaneous intracerebral hemorrhage: A guideline for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"46","author":"Hemphill","year":"2015","journal-title":"Stroke"},{"key":"ref_7","first-page":"3385","article-title":"Cerebral amyloid angiopathy-related lobar intracerebral haemorrhage in the Oxford Vascular Study","volume":"133","author":"Lovelock","year":"2010","journal-title":"Brain"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1111\/ijs.12309","article-title":"European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage","volume":"9","author":"Steiner","year":"2014","journal-title":"Int. J. Stroke"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1016\/S0140-6736(13)60986-1","article-title":"Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): A randomised trial","volume":"382","author":"Mendelow","year":"2013","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/S0140-6736(05)70233-6","article-title":"Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral hemorrhage in the International Surgical Trial in Intracerebral Haemorrhage (STICH): A randomised trial","volume":"365","author":"Mendelow","year":"2005","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"617","DOI":"10.3109\/02688697.2013.765938","article-title":"Surgical treatment for large spontaneous basal ganglia hemorrhage: Retrospective analysis of 253 cases","volume":"27","author":"Li","year":"2013","journal-title":"Br. J. Neurosurg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e4","DOI":"10.3346\/jkms.2021.36.e4","article-title":"Comparative analysis of patients with spontaneous thalamic hemorrhage with concurrent intraventricular hemorrhage versus those without: Cohort study of 233 patients","volume":"36","author":"Nam","year":"2021","journal-title":"J. Korean Med. Sci."},{"key":"ref_13","first-page":"291","article-title":"The MISTIE III trial: A neurosurgical evaluation of minimally invasive surgery plus rtPA for intracerebral hemorrhage evacuation","volume":"86","author":"Hanley","year":"2020","journal-title":"Neurosurgery"},{"key":"ref_14","unstructured":"NICO Corporation (2025, July 27). Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH), Available online: https:\/\/clinicaltrials.gov\/study\/NCT02880878."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e199","DOI":"10.1161\/STR.0000000000000464","article-title":"2024 AHA\/ASA performance and quality measures for spontaneous intracerebral hemorrhage","volume":"55","author":"Ruff","year":"2024","journal-title":"Stroke"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Steiner, T., Purrucker, J.C., Aguiar de Sousa, D., Apostolaki-Hansson, T., Beck, J., Christensen, H., Cordonnier, C., Downer, M.B., Eilertsen, H., and Gartly, R. (2025). European Stroke Organisation and European Association of Neurosurgical Societies guideline on stroke due to spontaneous intracerebral haemorrhage. Eur. Stroke J., Online ahead of print.","DOI":"10.1177\/23969873251340815"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Akram, M.J., Zhao, R., Shen, X., Yang, W.S., Deng, L., Li, Z.Q., Hu, X., Zhao, L.B., Xie, P., and Li, Q. (2022). Surgical vs. conservative management for lobar intracerebral hemorrhage: A meta-analysis of randomized controlled trials. Front. Neurol., 12.","DOI":"10.3389\/fneur.2021.742959"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1212\/WNL.51.5.1359","article-title":"Surgical treatment for intracerebral hemorrhage (STICH): A single-center, randomized clinical trial","volume":"51","author":"Morgenstern","year":"1998","journal-title":"Neurology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3","DOI":"10.5853\/jos.2016.00864","article-title":"Epidemiology, risk factors, and clinical features of intracerebral hemorrhage: An update","volume":"19","author":"An","year":"2017","journal-title":"J. Stroke"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e282","DOI":"10.1161\/STR.0000000000000407","article-title":"2022 Guideline for the Management of Patients with Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association\/American Stroke Association","volume":"53","author":"Greenberg","year":"2022","journal-title":"Stroke"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2395","DOI":"10.1016\/S0140-6736(24)00702-5","article-title":"Decompressive craniectomy plus best medical treatment versus best medical treatment alone for spontaneous severe deep supratentorial intracerebral haemorrhage: A randomised controlled clinical trial","volume":"403","author":"Beck","year":"2024","journal-title":"Lancet"},{"key":"ref_22","first-page":"111","article-title":"Minimally invasive surgery for basal ganglia hemorrhage: A meta-analysis of randomized controlled trials","volume":"5","author":"Zhou","year":"2020","journal-title":"Stroke Vasc. Neurol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1056\/NEJMoa2308440","article-title":"Trial of early minimally invasive removal of intracerebral hemorrhage","volume":"390","author":"Pradilla","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.1161\/STROKEAHA.121.037438","article-title":"Intraventricular hemorrhage expansion in the CLEAR III trial: A post hoc exploratory analysis","volume":"53","author":"Roh","year":"2022","journal-title":"Stroke"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1136\/practneurol-2020-002763","article-title":"Acute intracerebral haemorrhage: Diagnosis and management","volume":"21","author":"McGurgan","year":"2021","journal-title":"Pract. Neurol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2355","DOI":"10.1056\/NEJMoa1214609","article-title":"Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage","volume":"368","author":"Anderson","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_27","first-page":"1248","article-title":"Potential contraindications to the early surgical management of intracerebral hemorrhage: Observations from CT","volume":"76","author":"Mitchell","year":"2005","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_28","first-page":"5","article-title":"Imaging-based selection of patients for treatment of acute stroke: A systematic review","volume":"82","author":"Naggara","year":"2011","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e234","DOI":"10.1097\/CCM.0000000000003013","article-title":"Outcomes and costs of patients admitted to the ICU due to spontaneous intracranial hemorrhage","volume":"46","author":"Fernando","year":"2018","journal-title":"Crit Care Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/s12028-012-9793-y","article-title":"The epidemiology of intracerebral hemorrhage in the United States from 1979 to 2008","volume":"19","author":"Rincon","year":"2013","journal-title":"Neurocrit. Care"},{"key":"ref_31","unstructured":"C\u00eendea, C.-N. (2025). Study on the profile of patients with spontaneous intracerebral hemorrhage: Clinical and epidemiological analysis within the Sibiu County Emergency Clinical Hospital (2017\u20132023). Zenodo."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/15\/5372\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:18:49Z","timestamp":1760033929000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/15\/5372"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,30]]},"references-count":31,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["jcm14155372"],"URL":"https:\/\/doi.org\/10.3390\/jcm14155372","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,30]]}}}