Patients with ICH, diagnosed on the basis MR in trombolysis project are prepared for ultra early evacuation. Open microsurgery and transylvian approach with exact coagulation of bleeding sources to exclude secondary bleeding, rapid and complete evacuation of hematoma minimizes the secondary brain injury. Initial ability of brain tissue to compensate this changes suggests a therapeutic time window. Prospective study is designed for 3 yrs, inclusion criteria: spontaneous ICH, volume > 30 ml, GSC > 8, time to surgery 5-8 hrs or less, best treatment in neurosurgical ICU with multimodality monitoring including computer analysis of ICP with the parameter of mean wave amplitude. Experiences of 2yrs are presented : average time interval 3.5 hrs, no death, final results varied widely. The indication for ICH surgery is still controversial, but "early is better " and "open microsurgery is method of choice" are possibilities, identification of patient with real benefit after surgery is still difficult. - goal is independency in daily living actvites.
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