Abstract Background: The indication for surgical intervention in spontaneous intracerebral hemorrhage remains controversial, particularly regarding the benefits of early hematoma drainage via open craniotomy. This study aimed to identify the maximum hematoma volume suitable for conservative treatment and the volume that represents an absolute indication for surgery in patients with basal ganglia hemorrhage. Methods: A retrospective analysis was performed on the medical records of patients admitted for basal ganglia hemorrhage from 2019 to 2021. The data encompassed personal history, general information and diagnostic imaging records, particularly CT brain scans from the initial ER visit, were examined to ascertain hematoma volume. The comparison focused on evaluating the outcomes of patients who received medical treatment compared to those who underwent surgical intervention, mainly considering various hematoma volumes, and was conducted using multivariate logistic analysis. Results: In a study of 387 cases of basal ganglia hemorrhage, analysis of medical treatment alone across various hematoma volumes revealed that the group with volumes between 10 and 39.9 ml showed no significant difference in mortality compared to the group with volumes less than 10 ml. The Receiver Operating Characteristics (ROC) curve identified a 45.3 ml cutoff for survival prediction with medical treatment alone. Notably, patients in the subgroup undergoing surgical intervention with a hematoma volume less than 30 ml exhibited significantly higher mortality than those who did not undergo surgery. Conversely, there was a pronounced and statistically significant trend toward increased survival in the group with a hematoma volume of at least 60 ml. Conclusions: The application of medical treatment alone is suitable for hematoma volumes ranging from 0 to 45.3 ml, whereas volumes of 60 ml or more serve as a clear indication for surgical intervention in patients with basal ganglia hemorrhage.

The authors have declared no competing interest.

Because this paper is an observational retrospective cohort study that utilizes only existing data, we understand that it may not be eligible for registration on ClinicalTrials.gov. However, we plan to register this paper as soon as possible

-

No funding was received for this research.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Not Applicable

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Human Research Ethics Committee of Ratchaburi Hospital, Ratchaburi, Thailand tel (+66)32-719600 # 1643

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Not Applicable

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Not Applicable

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Not Applicable

The data that support the findings of this study are available from the first author, where data were recorded in Google Drive. The data supporting the findings of this study are available upon reasonable request via email at chonnaweethailand@gmail.com.

-