PRECISION SELECTION FOR MINIMALLY INVASIVE HEMATOMA EVACUATION IN SPONTANEOUS INTRACEREBRAL HEMORRHAGE: INTEGRATING HEMATOMA TOPOGRAPHY, SURGICAL TIMING, IMAGING BIOMARKERS, AND FUNCTIONAL RECOVERY

Abstract

Background. Spontaneous intracerebral hemorrhage is a devastating cerebrovascular disorder associated with substantial mortality, long-term neurological impairment, and functional dependence. Although surgical hematoma evacuation can reduce intracranial mass effect and secondary tissue injury, the clinical effectiveness of surgery differs according to hematoma location, surgical timing, procedural technique, and neurological severity. Recent randomized clinical trials have renewed interest in minimally invasive hematoma evacuation.

Materials and Methods. A narrative analytical review of international guidelines, randomized controlled trials, observational investigations, and systematic reviews was performed. The evaluation focused on hematoma volume and location, computed tomography biomarkers, timing of intervention, evacuation techniques, perioperative complications, and functional outcomes.

Results. Evidence suggests that the clinical effectiveness of hematoma evacuation is influenced by anatomical location, baseline neurological condition, hematoma stability, technical completeness of evacuation, and access to comprehensive neurocritical care. Early minimally invasive evacuation has demonstrated functional benefit in selected patients with lobar hemorrhage, whereas results for deep hemorrhages remain less definitive. A conceptual ICH-SELECT assessment matrix was developed to organize potentially relevant determinants of surgical suitability and postoperative recovery.

Conclusion. Precision-oriented selection for minimally invasive hematoma evacuation should integrate hemorrhage topology, clinical severity, radiological characteristics, procedural feasibility, and rehabilitation potential. The proposed framework requires prospective validation before application as a clinical prediction instrument.