“Prevention is the best way to treat brain bleeding. Treatment of hypertension is the key. Leading brain surgeon on intracranial bleeding treatment options and prognosis. Intracerebral hemorrhage is one of your particular interest areas in clinical work. Dr. Anton Titov, MD. You also do research in bleeding inside the brain. Yes. You have done research on early and late prognostic factors for the outcomes of patients with intracerebral hemorrhage. Dr. Anton Titov, MD. What have you learned from your research about bleeding into the brain? Dr. Mika Niemela, MD. Brain bleeding was studied here in Helsinki for almost 30 years. There were several case series of patients with intracerebral hemorrhage. Unfortunately, the brain bleeding prognosis has not changed much. It does not matter whether we treat cerebral hemorrhage or not. Surgery has not been proven to be very beneficial. Dr. Mika Niemela, MD. Surgery does not help much when hypertensive brain bleeding happens in the basal ganglia area. The brain bleeding could be in the posterior fossa of the skull. It could cause hydrocephalus. Then treatment may be advocated mainly due to the hydrocephalus. But if there is no hydrocephalus in the posterior fossa brain hematoma, it's better not to operate on brain hemorrhage directly. Dr. Anton Titov, MD. Prevention is the best method to treat brain bleeding. Treatment of hypertension is the key. Hypertension, especially in Asia, may be a problem. There are more hypertensive brain bleeds than ischemic strokes. In the Western countries there is more ischemic strokes than brain hemorrhages. Maybe it is due to a different diet. Dr. Mika Niemela, MD. In Western European population ischemic stroke is maybe a more problem than a brain bleeding. There is more hypertension in patients as you go to the East. Hypertension may be treated or untreated. Dr. Anton Titov, MD. Patients may have untreated hypertension. Then have more brain bleeds. Dr. Mika Niemela, MD. That is why prevention is the key to prognosis in intracerebral bran bleeding. It is not surgery. We only treat brain cavernoma, or brain aneurysm, or Arteriovenous Malformation. They could. be a cause of bleeding into the brain.