HomeStrokeVol. 39, No. 4Response to Letter by Morikawa Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBResponse to Letter by Morikawa Joseph P. Broderick, MD, FAHA E. S. Connolly, MD, FAHA Carlos S. Kase, MD, FAHA Paul Vespa, MD Derk W. Krieger, MD Daniel F. Hanley, MD, FAHA Marc Mayberg, MD, FAHA Edward Feldmann, MD, FAHA Lewis B. Morgenstern, MD, FAHA Mario Zuccarello, MD Christopher S. Ogilvy, MD Joseph P. BroderickJoseph P. Broderick Division of Neurology, University of Cincinnati, Cincinnati, Ohio Search for more papers by this author E. S. ConnollyE. S. Connolly Columbia University Search for more papers by this author Carlos S. KaseCarlos S. Kase Boston University Medical Center, Boston, Mass Search for more papers by this author Paul VespaPaul Vespa University of California, Los Angeles, Los Angeles, Calif Search for more papers by this author Derk W. KriegerDerk W. Krieger The Cleveland Clinic Foundation, Cleveland, Ohio Search for more papers by this author Daniel F. HanleyDaniel F. Hanley Johns Hopkins University, Baltimore, Md Search for more papers by this author Marc MaybergMarc Mayberg Seattle Neuroscience Institute Search for more papers by this author Edward FeldmannEdward Feldmann Brown Medical School Search for more papers by this author Lewis B. MorgensternLewis B. Morgenstern The University of Michigan Health System Search for more papers by this author Mario ZuccarelloMario Zuccarello University of Cincinnati, Cincinnati, Ohio Search for more papers by this author Christopher S. OgilvyChristopher S. Ogilvy Massachusetts General Hospital, Harvard Medical School, Boston, Mass Search for more papers by this author Originally published28 Feb 2008https://doi.org/10.1161/STROKEAHA.107.509513Stroke. 2008;39:e70Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: February 28, 2008: Previous Version 1 Response:We appreciate the comments by Dr Morikawa concerning the role of craniotomy in patients with intracerebral hemorrhage. Dr Morikawa is correct in saying that the STICH trial provided the best and most robust data, and the highest level of evidence, for recommendations regarding the role of craniotomy for patients with ICH. Although the crossover rate from initial medical to surgical treatment is a limitation of the STICH trial, the present Guidelines for Management of ICH reflect that patients in the STICH Trial with lobar ICH near the brain surface may benefit from surgical removal whereas those with deep hemorrhages tended to do more poorly with craniotomy.These observations about the influence of location on surgical decision making from the STICH trial are post hoc in nature and require further study. STICH II is currently examining the role of early surgical removal versus initial conservative medical treatment for lobar ICH. The Guidelines also indicate that less-invasive approaches to deep ICH should be pursued in ongoing and future clinical trials.Based on the best available data, routine craniotomy for deep ICH is not recommended but is still an option for treating physicians in selected patients. This recommendation is open to revision with publication of new data from a randomized trial that addresses this issue.DisclosuresNone. Previous Back to top Next FiguresReferencesRelatedDetails April 2008Vol 39, Issue 4 Advertisement Article InformationMetrics https://doi.org/10.1161/STROKEAHA.107.509513 Originally publishedFebruary 28, 2008 PDF download Advertisement