Revisiting traumatic intracerebral hemorrhage in the context of ENRICH: illustrative cases.

Background: Traumatic intracerebral hemorrhage (tICH) is a common form of intracranial hemorrhage after traumatic brain injury (TBI). The role of surgical intervention in tICH remains a subject of discussion. Recent trials, such as Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH), have shown the efficacy of minimally invasive clot evacuation for non-tICH for hemorrhages with volumes of 30-80 mL. The generalizability of ENRICH to tICH remains unclear; however, it demonstrates the need for rigorous studies evaluating the efficacy of surgical intervention in tICH versus medical management.

Observations: Here the authors present 2 cases of tICH, both in the dominant temporal lobe, of similar volumes. One case was managed surgically and the other medically. The decision to operate on the first patient was due to interval enlargement of the hematoma. In the second patient, the decline in neurological examination was attributable to perilesional edema, and the decision was made to manage the patient medically. Both patients ultimately had good outcomes.

Lessons: The management of patients with tICH remains challenging. However, having a sophisticated understanding of the biological processes underlying the patient's presentation is paramount in delivering optimal management. Larger and more granular studies are needed in order to further clarify the role of operative intervention in patients with tICH. https://thejns.org/doi/10.3171/CASE24591.