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al19 also revealed that 13 of 23 patients with putaminal he- matomas who underwent hemicraniectomy achieved a good outcome. What is more, another comparative study by Maira et al14 reported a better outcome for 15 patients with primary supratentorial ICH who underwent craniec- tomy in addition to immediate hematoma evacuation compared with another 14 patients who received hema- toma evacuation only.
Although it was assumed that craniotomy might jeopar- dize patients with deep-seated ICH, little evidence con- firmed that better functional outcome could be provided by less invasive approaches such as stereotactic or endo- scopic puncture.20,21 On the other hand, SBH reveals itself as different stages of consciousness, changing from deep coma to full consciousness with minor neurologic deficit.22 Therefore, treatment should be individualized. The cur- rent study included patients with neurologic deteriora- tion, half of whom showed signs of cerebral herniation, thus two different emergency surgeries were performed as life-saving procedures. However, it was noted that the baseline characteristics were not balanced because of the retrospective study design and patients in the decompres- sive craniectomy group were associated with poorer clini- cal condition before surgery. To evaluate the independent effect of the intervention method on outcomes, multivari- ate logistics regression was conducted and cerebral herni- ation and ICH score were found as confounders to treatment method in the analyses. Cerebral herniation is a known risk factor for mortality. According to literature, the mortality in patients with or without signs of hernia- tion was 76% and 11%, respectively, in surgical interven- tion group. In addition, the death rate could be as high as 97% in these patients if conservative treatment was per- formed. Given this information, t