To comprehensively classify hypertensive intracerebral hemorrhage (HICH) according to clinical needs, and to find appropriate surgical methods for each type based on patient’s condition and hematoma volume.

The clinical data of 380 eligible HICH patients in our two hospitals from December 2013 to December 2018 were collected. The surgical methods were craniotomy and minimally invasive treatment (catheter drainage of hematoma). All cases were classified according to the location of hematoma. Then 240 patients with hematoma located in the cerebral lobe and basal ganglia, who underwent craniotomy or minimally invasive surgery, were divided into two groups according to the degree of consciousness disturbance: Non coma group and coma group. Each group was divided into craniotomy group and minimally invasive treatment group according to the surgical methods. The outcomeof two groups (non coma group and coma group) were compared. There were 120 patients in the non coma group with GCS of 10-14 points. There were 120 patients in the coma group with GCS of 4-9 points.

Classification statistics of HICH patients: 51 cases of lobar hemorrhage, 208 cases of basal ganglia hemorrhage, 59 cases of thalamus hemorrhage, 23 cases of mixed hemorrhage, 18 cases of cerebellar hemorrhage, 9 cases of brainstem hemorrhage, 6 cases of primary ventricular hemorrhage and 6 cases of multiple cerebral hemorrhage. In the non coma group, the mortality rate of patients with craniotomy and minimally invasive treatment was 3.8% and 4.5%, respectively, with no significant difference (P>0.05). The most common hemorrhage in lobar and basal ganglia was compared. In coma group, the mortality rate of patients with craniotomy was 10.6%, and that of minimally invasive treatment was 25.6%, the difference was statistically significant (P<0.05).

In the treatment of HICH, the operation mode should be selected according to the classification, the degree of consciousness disturbance, the amount of bleeding and other factors, and the thinking mode of only one operation method should be abandoned, which not only reduces the large trauma and high cost of craniotomy, but also reduces the mortality of minimally invasive treatment.