Spontaneous intracerebral hematoma acutely increases intracranial volume together with a change in intracranial compliance. It causes an increase in intracranial pressure (ICP) and a decrease in cerebral perfusion. We analysed the transfer to the CT, the volume of the hematoma, the values and relationship between the preoperative intracranial pressure (ICP) before and after stereotactic evacuation with recording of the intraparenchymal ICP and pressure in the hematoma, including analysis of the amplitude and form of the ICP waveform. Forty-eight patients with supratentorial spontaneous intracerebral hematoma (ICH) with an average age 56.2 years (± 19.5) were evaluated. There were 28 (58 %) men and 20 (42 %) women in this group. Supratentorial spontaneous intracerebral hematoma was localised in 27 (56 %) patients on the left side and in 21 (44%) patients on the right side. The first neurological examinations of patients were performed at an average interval of 13 (± 11) hours. Most of the first CT examinations were performed within 16 hours. The interval from the hemorrhage to the operation was 30.5 (17–42 hours) in this group of patients. For the evacuation, we used the frame-based stereotaxy with the Riechert- Mundinger stereotactic system and the CT localisation. The ICP during stereotactic evacuation was measured peroperatively by parenchymal set made by the Codman company. The initial intraparenchymal ICP levels were divided into categories as follows: the high ICP (above 40 mmHg in 3 (6%)) with an average ICP of 42 mmHg, the moderate ICP (25 – 39 mmHg in 19 (40%)) with an average ICP of 29.7 mmHg, the low ICP (below 24 mmHg in 3 (6%)) with an average ICP of 19.5 mmHg. Average ICP after evacuation: no patient in the high category, in the moderate category (26.5 mmHg): 2 patients (4%), and in the low category (14.2 mmHg): 46 patients (96%). We also analysed the form of the ICP waveform together with an assessment of the level of decompensation. Our data and the analysis of dynamic changes occurring during the stereotactic evacuation suggest that this procedure significantly reduces the ICP caused by ICH and we believe that our results can improve management of patients with spontaneous intracerebral hematoma.

        Key words: intracerebral hematoma, stereotactic evacuation, monitoring of intracranial pressure