Research Progress in the Treatment of Lobar Intracerebral Hemorrhage

doi:10.3969/j.issn.1673-5765.2026.08.013

Abstract

Abstract: As a unique subtype of intracerebral hemorrhage, lobar intracerebral hemorrhage exhibits a high recurrence rate and a higher tendency to cause focal neurological deficits. Individualized treatment protocols are essential for improving patient prognosis. In terms of medical management, treatments for lobar intracerebral hemorrhage vary according to its distinct etiologies. For instance, stricter blood-pressure control is required in patients with cerebral amyloid angiopathy, and long-term anticoagulation ought to be avoided where possible. Continuous neurological monitoring and prophylactic antiepileptic therapy should also be administered. Regarding surgical intervention, a hematoma volume exceeding 30 mL is widely adopted as a surgical indication in clinical practice. Nevertheless, the optimal surgical timing and operative approaches remain controversial. This article systematically reviews research advances in etiological classification, stratified medical and surgical management and prognostic factors of lobar intracerebral hemorrhage. It aims to provide references for clinicians to accomplish early-stage classification and formulate precise therapeutic regimens.

Key words: Lobar intracerebral hemorrhage; Cerebral amyloid angiopathy; Treatment; Management; Prognosis

摘要： 作为脑出血的特殊亚型，脑叶出血复发率高，更容易出现局灶性神经功能障碍，制订个性化治疗方案对改善患者预后至关重要。在内科管理层面，脑叶出血应根据其特殊病因进行差异性治疗，如脑淀粉样血管病患者的血压控制应更严格，尽量避免长期抗凝，同时应开展持续神经功能监测和预防性抗癫痫治疗。在外科治疗层面，临床上虽多以血肿量＞30 mL作为脑叶出血的手术干预指征，但其手术时机及手术方式选择目前仍存在一定争议。本文系统梳理脑叶出血的病因分型、内外科分层治疗及预后影响因素的相关研究进展，以期为临床医师早期识别脑叶出血分型、制订精准治疗方案提供参考。

关键词: 脑叶出血; 脑淀粉样血管病; 治疗; 管理; 预后

CLC Number:

DENG Nan, WANG Likun. Research Progress in the Treatment of Lobar Intracerebral Hemorrhage[J]. Chinese Journal of Stroke, 2026, 21(8): 1031-1037.

邓楠, 王丽琨. 脑叶出血治疗的研究进展[J]. 中国卒中杂志, 2026, 21(8): 1031-1037.

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URL: https://www.chinastroke.org.cn/EN/10.3969/j.issn.1673-5765.2026.08.013

https://www.chinastroke.org.cn/EN/Y2026/V21/I8/1031

References

[1] Sacco R L. Lobar intracerebral hemorrhage[J]. N Engl J Med，2000，342（4）：276-279.
[2] Zhang Jing，Zhang Neng，Li Xia，et al. Retrospective analysis of prognostic factors in HICH patients after neuroendoscopic hematoma evacuation[J/OL]. Sci Rep，2024，14（1）：29505.https://doi.org/10.1038/s41598-024-81106-6.
[3] Samarasekera N，Fonville A，Lerpiniere C，et al. Influence of intracerebral hemorrhage location on incidence，characteristics，and outcome：population-based study[J]. Stroke，2015，46（2）：361-368.
[4] Morotti A，Li Qi，Nawabi J，et al. Volume tolerance and prognostic impact of hematoma expansion in deep and lobar intracerebral hemorrhage[J]. Stroke，2025，56（5）：1224-1231.
[5] Longatti P，Basaldella L. Endoscopic management of intracerebral hemorrhage[J/OL]. World Neurosurg，2013，79（S2）：S17.e1-S17.e7. https://doi.org/10.1016/j.wneu.2012.02.025.
[6] Vespa P，Hanley D，Betz J，et al. ICES（intraoperative stereotactic computed tomography-guided endoscopic surgery） for brain hemorrhage：a multicenter randomized controlled trial[J]. Stroke，2016，47（11）：2749-2755.
[7] Puy L，Boe N J，Maillard M，et al. Recent and future advances in intracerebral hemorrhage[J/OL]. J Neurol Sci，2024，467：123329. https://doi.org/10.1016/j.jns.2024.123329.
[8] Wang Dandan，Lyu Shuxian，Wei Yuqing，et al. Imaging and fluid biomarkers for prognostic stratification in cerebral amyloid angiopathy[J/OL]. J Neurol，2026，273（2）：90. https://doi.org/10.1007/s00415-026-13626-2.
[9] Charidimou A，Imaizumi T，Moulin S，et al. Brain hemorrhage recurrence，small vessel disease type，and cerebral microbleeds：a meta-analysis[J]. Neurology，2017，89（8）：820-829.
[10] Cozza M，Amador L，Boccardi V. Exploring cerebral amyloid angiopathy：insights into pathogenesis，diagnosis，review[J/OL]. J Neurol Sci，2023，454：120866. https://doi.org/10.1016/j.jns.2023.120866.
[11] Linn J，Halpin A，Demaerel P，et al. Prevalence of superficial siderosis in patients with cerebral amyloid angiopathy[J]. Neurology，2010，74（17）：1346-1350.
[12] Rodrigues M A，Samarasekera N，Lerpiniere C，et al. The Edinburgh CT and genetic diagnostic criteria for lobar intracerebral haemorrhage associated with cerebral amyloid angiopathy：model development and diagnostic test accuracy study[J]. Lancet Neurol，2018，17（3）：232-240.
[13] Maury A，Benzakoun J，Bani-Sadr A，et al. Diagnostic accuracy of finger-like projections and subarachnoid hemorrhage for cerebral amyloid angiopathy：pathological validation from lobar hematoma evacuation or brain biopsy[J]. Stroke，2025，56（8）：2190-2197.
[14] Morotti A，Busto G，Bernardoni A，et al. Comparison of perihematomal perfusion in deep and lobar intracerebral hemorrhage[J]. Neuroradiology，2020，62（2）：257-261.
[15] Myserlis E P，Mayerhofer E，Abramson J R，et al. Lobar intracerebral hemorrhage and risk of subsequent uncontrolled blood pressure[J]. Eur Stroke J，2022，7（3）：280-288.
[16] Goldstein J N，Greenberg S M. Should anticoagulation be resumed after intracerebral hemorrhage？[J]. Cleve Clin J Med，2010，77（11）：791-799.
[17] Cordonnier C，Klijn C，Smith E E，et al. Diagnosis and management of cerebral amyloid angiopathy：a scientific statement from the International CAA Association and the World Stroke Organization[J]. Int J Stroke，2025，20（8）：949-967.
[18] Intercollegiate Stroke Working Party. National clinical guideline for stroke for the UK and Ireland[EB/OL].（2023-05-04）[2026-06-30]. https://www.strokeguideline.org.
[19] Cheng Yajun，Wang Yanan，Song Quhong，et al. Use of anticoagulant therapy and cerebral microbleeds：a systematic review and meta-analysis[J]. J Neurol，2021，268（5）：1666-1679.
[20] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南（2019）[J]. 中华神经科杂志，2020，53（1）：8-24.
Chinese Neurological Society，Cerebrovascular Disease Group of Chinese Neurological Society. China guidelines for diagnosis and treatment of spontaneous intracerebral hemorrhage（2019）[J]. Chin J Neurol，2020，53（1）：8-24.
[21] Steiner T，Purrucker J C，Aguiar De Sousa D，et al. European Stroke Organisation（ESO）and European Association of Neurosurgical Societies（EANS）guideline on stroke due to spontaneous intracerebral haemorrhage[J]. Eur Stroke J，2025，10（4）：1007-1086.
[22] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国脑淀粉样血管病诊治共识（2023版）[J]. 中华神经科杂志，2024，57（10）：1051-1074.
Chinese Neurological Society，Cerebrovascular Disease Group of Chinese Neurological Society. Chinese consensus on the diagnosis and treatment of cerebral amyloid angiopathy（2023 version）[J]. Chin J Neurol，2024，57（10）：1051-1074.
[23] Hessington A，Tsitsopoulos P P，Fahlström A，et al. Favorable clinical outcome following surgical evacuation of deep-seated and lobar supratentorial intracerebral hemorrhage：a retrospective single-center analysis of 123 cases[J]. Acta Neurochir（Wien），2018，160（9）：1737-1747.
[24] Greenberg S M，Ziai W C，Cordonnier C，et al. 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage：a guideline from the American Heart Association/American Stroke Association[J/OL]. Stroke，2022，53（7）：e282-e361. https://doi.org/10.1161/STR.0000000000000407.
[25] Banker M，Do Nascimento J S P，Shownkeen H，et al. Prophylactic antiseizure medication in patients with lobar intracerebral hemorrhage[J]. Neurocrit Care，2026，44（3）：850-856.
[26] Pradilla G，Ratcliff J J，Hall A J，et al. Trial of early minimally invasive removal of intracerebral hemorrhage[J]. N Engl J Med，2024，390（14）：1277-1289.
[27] Mendelow A D，Gregson B A，Rowan E N，et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas（STICH Ⅱ）：a randomised trial[J]. Lancet，2013，382（9890）：397-408.
[28] Luzzi S，Elia A，Del Maestro M，et al. Indication，timing，and surgical treatment of spontaneous intracerebral hemorrhage：systematic review and proposal of a management algorithm[J/OL]. World Neurosurg，2019，124：e769-e778. https://doi.org/10.1016/j.wneu.2019.01.016.
[29] Fang Yuanjian，Wang Junjie，Chen Luxi，et al. Functional outcome analysis of stereotactic catheter aspiration for spontaneous intracerebral hemorrhage：early or late hematoma evacuation？[J/OL]. J Clin Med，2023，12（4）：1533. https://doi.org/10.3390/jcm12041533.
[30] Behle B，Beseoglu K，Beez T，et al. Profile and prognosis of spontaneous lobar intracerebral hemorrhage：comparison of 6-month survival with STICH Ⅱ and the MISTIE Ⅲ lobar hemorrhage subset[J]. J Neurol Surg A Cent Eur Neurosurg，2022，83（1）：20-26.
[31] Akram M J，Zhao Rui，Shen Xue，et al. Surgical vs. conservative management for lobar intracerebral hemorrhage，a meta-analysis of randomized controlled trials[J/OL]. Front Neurol，2022，12：742959. https://doi.org/10.3389/fneur.2021.742959.
[32] Xu Xinghua，Zhang Huaping，Zhang Jiashu，et al. Minimally invasive surgeries for spontaneous hypertensive intracerebral hemorrhage （MISICH）：a multicenter randomized controlled trial[J/OL]. BMC Med，2024，22（1）：244. https://doi.org/10.1186/s12916-024-03468-y.
[33] De Herdt V，Dumont F，Hénon H，et al. Early seizures in intracerebral hemorrhage：incidence，associated factors，and outcome[J]. Neurology，2011，77（20）：1794-1800.
[34] Li Yuqian，Yang Ruixin，Li Zhihong，et al. Surgical evacuation of spontaneous supratentorial lobar intracerebral hemorrhage：comparison of safety and efficacy of stereotactic aspiration，endoscopic surgery，and craniotomy[J]. World Neurosurg，2017，105：332-340.
[35] Kayhan S，Yılmaz E. A single-center retrospective study on endoscopic surgery and craniotomy in spontaneous superficial supratentorial lobar hemorrhages：which approach yields better outcomes？[J/OL]. World Neurosurg，2026，205：124693. https://doi.org/10.1016/j.wneu.2025.124693.
[36] Bardutzky J，Hieber M，Roelz R，et al. Cerebral amyloid angiopathy-related intracerebral hemorrhage：feasibility and safety of bedside catheter hematoma evacuation with urokinase[J/OL]. Clin Neurol Neurosurg，2020，190：105655. https://doi.org/10.1016/j.clineuro.2019.105655.
[37] Kellner C P，Song Rui，Ali M，et al. Time to evacuation and functional outcome after minimally invasive endoscopic intracerebral hemorrhage evacuation[J/OL]. Stroke，2021，52（9）：e536-e539. https://doi.org/10.1161/STROKEAHA.121.034392.
[38] Teo K-C，Fong S-M，Leung W C Y，et al. Location-specific hematoma volume cutoff and clinical outcomes in intracerebral hemorrhage[J]. Stroke，2023，54（6）：1548-1557.
[39] Roh D，Sun C-H，Murthy S，et al. Hematoma expansion differences in lobar and deep primary intracerebral hemorrhage[J]. Neurocrit Care，2019，31（1）：40-45.
[40] Kuohn L R，Witsch J，Steiner T，et al. Early deterioration，hematoma expansion，and outcomes in deep versus lobar intracerebral hemorrhage：the FAST trial[J]. Stroke，2022，53（8）：2441-2448.
[41] Lattanzi S，Di Napoli M，Ricci S，et al. Matrix metalloproteinases in acute intracerebral hemorrhage[J]. Neurotherapeutics，2020，17（2）：484-496.
[42] Reitsma F J，Van Kuijk S M J，Werring D J，et al. Development and external validation of the LEAN score to predict late seizures after intracerebral haemorrhage[J/OL]. Eur Stroke J，2026，11（1）：23969873251350882. https://doi.org/10.1177/23969873251350882.
[43] De Reuck J，Hemelsoet D，Van Maele G. Seizures and epilepsy in patients with a spontaneous intracerebral haematoma[J]. Clin Neurol Neurosurg，2007，109（6）：501-504.
[44] Yogendrakumar V，Demchuk A M，Aviv R I，et al. Location of intracerebral haemorrhage predicts haematoma expansion[J]. Eur Stroke J，2017，2（3）：257-263.