Clinical Treatment for Intracerebral Hemorrhage

Dear Colleagues,

The treatment of intracranial bleeding is as varied as its causes and depends on the medical discipline which encounters the patient first. Intracerebral hemorrhages can be caused by ruptured brain aneurysms, arteriovenous malformations, arteriovenous fistulas, amyloid angiopathies, or hypertensive bleeding. There is a dispute on the treatment of such bleeding between disciplines. For example, a ruptured intracranial aneurysm can lead to a coil embolization first and removal of the bleeding second or vice versa. For a cerebrovascular surgeon, the treatment is the removal of bleeding and clipping of the aneurysm in most cases. The treatment is not as obvious as it is for the cerebrovascular surgeon if a neurologist encounters such a patient first. The same applies for the treatment of ruptured arteriovenous malformations. These patients can stay in a neurology ward for a longer time and be treated with an embolization of the malformation after the bleeding has been resorbed. Even a Gamma knife treatment after blood resolution can be an option. Sometimes the treatment is as different as possible, as long it does not involve surgery. There is a trend to avoid surgery at any price, which is not based on evidence but personal opinion in non-neurosurgical disciplines. The need to reach a consensus about the treatment of such patients and to clarify which treatment is optimal is more important than ever since a conservative discipline like neurology can be the first to encounter the patient, or interventional radiology instead of neurosurgery. The treatments we offer to patients can be different, but the data regarding the morbidity and mortality of each option should be clear in order to be able to specify guidelines. No matter which discipline sees a patient first, it should always be clear that neurosurgery and interventional neurology both have to discuss the treatment options for every patient and ensure the treatment is based on hard evidence, not just a doctor’s feeling. We cannot afford to rely on personal opinions for our therapies. The actual data allow for a clear evidence-based approach, or at least they provide space for a scientific, unemotional conversation about the right treatment.

In this Special Issue, we hope to collect publications which will help physicians lead patients to the right treatment in intracerebral hemorrhages depending on pathology and other factors.

Prof. Dr. Athanasios K. Petridis
Guest Editor

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• intracerebral hemorrhage
• intracerebral bleeding
• ruptured intracranial aneurysm
• arteriovenous malformation
• arteriovenous fistulas