Intracerebral Hemorrhage with Glasgow Coma Scale Score 5–12 and Supratentorial Hematoma >20–30 mL
This protocol addresses a defined subgroup of patients presenting with supratentorial intracerebral hemorrhage where both the size of the bleed and the level of consciousness fall within specific thresholds that influence the choice of intervention.
Clinical scenario
This protocol applies when all of the following are present:
- Supratentorial intracerebral hemorrhage
- Hematoma volume greater than 20 to 30 mL
- Glasgow Coma Scale (GCS) score in the moderate range: 5 to 12
Treatment goal
The target outcome for this intervention is reduction of the hematoma to an end-of-treatment clot size of 15 mL or less. Achieving this surgical aim is associated with both reduced mortality and improved functional outcomes.
Approach
In this clinical scenario, a minimally invasive surgical approach to hematoma evacuation is favoured over medical management alone — the full protocol specifies the technique selection, procedural considerations, and adjunct options.
Complete regimen, sequencing, and evidence summary available in the full protocol →
References
DOI: 10.1161/STR.0000000000000407
For patients with supratentorial ICH of >20- to 30-mL volume with GCS scores in the moderate range (5–12), minimally invasive hematoma evacuation with endoscopic or stereotactic aspiration with or without thrombolytic use can be useful to reduce mortality compared with medical management alone.
However, planned exploratory analyses of clot removal showed a significant association between extent of clot removal and both mortality and lower mRS score (0–3), specifically in those patients who achieved the surgical aim (end-of-treatment clot size ≤15 mL).
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