Objective To analyze the likelihood of recovery and prognostic factors in patients with massive anticoagulation-associated intracerebral hemorrhage treated with surgical evacuation after reversal of anticoagulation.
Design Retrospective case series.
Setting Neurological-Neurosurgical Intensive Care Unit at Mayo Clinic.
Patients Seventeen consecutive patients with large anticoagulation-associated intracerebral hemorrhage.
Intervention Surgical evacuation of intracerebral hemorrhage.
Main Outcome Measure Functional outcome was assessed using the modified Rankin scale.
Results Before surgery, all patients had pronounced (>1-cm) shift of the septum pellucidum and one third had clinical signs of uncal herniation. Still, favorable outcome (modified Rankin scale score 
3) was achieved by 11 patients (65%). All patients with good recovery awoke within 36 hours of surgery. Older age (P = .05) and serious systemic complications after surgery (P<.01) were significantly associated with lack of neurological recovery and fatal outcome.
Conclusions Emergency surgery for select deteriorating patients with large anticoagulation-associated intracerebral hemorrhage is compatible with favorable outcome despite the presence of clinical and radiological signs of herniation before the evacuation.
