Additional subgroup analysis suggested that the risk for a poor outcome was increased for patients who presented as comatose (GCS score 8). On the basis of these observations, the STICH II trial was undertaken.226,236 The STICH II trial addressed the question of whether early surgery would be beneficial for conscious patients with superficial lobar hemorrhage of 10 to 100 mm3 within 1 cm of the cortical surface and without IVH and who were admitted within 48 hours of ictus. Seventy-eight centers in 27 countries participated. The study randomized patients to early surgery (within 12 hours of randomization) plus medical manage- ment or medical management alone. The primary outcome was a prognosis-based dichotomized (favorable or unfavor- able) outcome of the extended Glasgow Outcome Scale. Forty-one percent of patients in the early surgery group had a favorable outcome compared with 38% in the medical arm; this difference was not statistically significant. A nonpre- specified subgroup analysis that included only patients with a poor prognosis (as defined by a specific equation used in STICH) showed that such patients were more likely to have a favorable outcome with early surgery; however, there was no advantage to early surgery for patients in the good prognosis category. A nonsignificant survival advantage was noted for the surgical arm. Twenty-one percent of patients random- ized to initial medical management ultimately underwent surgery, with the most common reason described as patient deterioration. The STICH II authors performed an updated meta-analysis of surgical trials reporting on 3366 patients.228 A significant advantage for surgery was shown when all patients were considered, but there was significant heteroge- neity in the data. 