Abstract

Objective
To conduct a comparative analysis of the effectiveness of surgical and conservative approaches in the treatment of hypertensive intracerebral hematomas (HICH), to identify key prognostic factors influencing outcomes, and to develop a clinical algorithm for optimizing therapeutic strategies.
Materials and Methods
A prospective cohort study was conducted involving 170 patients with HICH. Inclusion criteria: verified HICH by CT/MRI and complete clinical documentation. Neurological status was assessed using the Glasgow Coma Scale (GCS), along with neuroimaging data (hematoma volume, localization, displacement).
Results
Surgical intervention was performed in 53 patients (31.2%), while 117 patients (68.8%) received conservative therapy. The proportion of favorable outcomes was significantly higher in the surgical group (71.7% vs. 52.1%; p=0.016). After adjustment for baseline severity (GCS) and age in a multivariate model, surgical treatment remained an independent predictor of favorable outcome (OR=2.34, 95% CI: 1.12–4.89, p=0.024). Stratification by hematoma volume revealed that outcomes were comparable for small hematomas (<30 ml) (62.5% vs. 60.0%; p=0.854). For medium volumes (30–60 ml), favorable outcomes were more frequent in the surgical group (84.0% vs. 52.4%; p=0.021), and for large hematomas (>60 ml), outcomes were markedly better (58.3% vs. 12.5%; p=0.009).
Conclusion
Hematoma volume is a key prognostic factor. Conservative therapy is effective for small hematomas, whereas surgical intervention significantly improves outcomes for medium and large hematomas. The developed algorithm, based on age, level of consciousness, and hematoma volume, allows for the standardization of treatment strategies.

Keywords

Hypertensive intracerebral hematomas (HICH) surgical treatment conservative therapy Glasgow Coma Scale (GCS) outcomes treatment algorithm.

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