Surgical Outcome in Patients with Spontaneous Supratentorial Intracerebral Hemorrhage

Open access

Summary

The aim of the paper was to evaluate the surgical outcome in patients with spontaneous supratentorial intracerebral hemorrhage (ICH) after surgical intervention, in respect to the initial clinical conditions, age, sex, hemispheric side and anatomic localization of ICH. Thirty-eight surgically treated patients with spontaneous supratentorial intracerebral hemorrhage were included in the study. The surgical outcome was evaluated three months after the initial admission, according to the Glasgow Outcome Scale (GOS). The surgical treatment was successful in 14 patients (37%), whereas it was unsuccessful in 24 patients (63%). We have detected a significant negative correlation between the Glasgow Coma Scale (GCS) scores on admission and the GOS scores after three months, suggesting worse neurological outcome in patients with initially lower GCS scores. The surgical outcome in patients with ICH was not affected by the sex, the hemispheric side and the anatomic localization of ICH, but the age of the patients was estimated as a significant factor for their functional outcome, with younger patients being more likely to be treated successfully. The surgical outcome is affected from the initial clinical state of the patients and their age. The treatment of ICH is still an unsolved clinical problem and the development of new surgical techniques with larger efficiency in the evacuation of the hematoma is necessary, thus making a minimal damage to the normal brain tissue, as well as decreasing the possibility of postoperative bleeding.

1. Skidmore CT, Andrefsky J. Spontaneous intracerebral hemorrhage: epidemiology, pathophysiology and medical management. Neurosurg Clin N Am 2002; 13:281-8. https://doi.org/10.1016/S1042-3680(02)00019-0

2. Qureshi AI, Mendelow AD, Hanley DF. Intracerebral haemorrhage. Lancet 2009; 373: 1632–44. https://doi.org/10.1016/S0140-6736(09)60371-8

3. Grysiewicz RA, Thomas K, Pandey DK. Epidemiology of ischemic and hemorrhagic stroke: incidence, prevalence, mortality, and risk factors. Neurol Clin 2008; 26:871-95. https://doi.org/10.1016/j.ncl.2008.07.003

4. Jakubovic R, Aviv RI. Intracerebral hemorrhage: toward physiological imaging of hemorrhage risk in acute and chronic bleeding. Front Neurol 2012; 3:86. https://doi.org/10.3389/fneur.2012.00086

5. Broderick JP, Adams HP, Barsan W et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 1999;30:905-15. https://doi.org/10.1161/01.STR.30.4.905

6. van Asch CJ, Luitse MJ, Rinkel GJ et al. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol 2010; 9:167–76. https://doi.org/10.1016/S1474-4422(09)70340-0

7. Broderick JP, Brott T, Tomsick T et al. The risk of subarachnoid and intracerebral hemorrhage in blacks as compared with whites. N Engl J Med 1992; 326:733-6. https://doi.org/10.1056/NEJM199203123261103

8. Furlan AJ, Whisnant JP, Elveback LR. The decreasing incidence of primary intracerebral hemorrhage: a population study. Ann Neurol 1979; 5:367-73. https://doi.org/10.1002/ana.410050410

9. Giroud M, Gras P, Chadan N et al. Cerebral hemorrhage in a French procpective population study. J Neurol Neurosurg Psychiatry 1991; 54:595-8. https://doi.org/10.1136/jnnp.54.7.595

10. D'Ambrosio A, Sughrue ME, Yorgason J et al. Decompressive hemicraniectomy for poor-grade aneurysmal subarachnoid hemorrhage patients with associated intracerebral hemorrhage: clinical outcome and quality of life assessment. Neurosurgery 2005; 56:12–9. https://doi.org/10.1227/01.NEU.0000144820.38439.63

11. Keep RF, Hua Y, Xi G. Intracerebral haemorrhage: mechanisms of injury and therapeutic targets. Lancet Neurol 2012; 11:720-31. https://doi.org/10.1016/S1474-4422(12)70104-7

12. Wagner KR. Modeling intracerebral hemorrhage: glutamate, nuclear factor-kappa B signaling and cytokines. Stroke. 2007; 38(2 Suppl):753-8. https://doi.org/10.1161/01.STR.0000255033.02904.db

13. Adeoye O, Broderick JP. Advances in the management of intracerebral hemorrhage. Nat Rev Neurol 2010; 6: 593–601. https://doi.org/10.1038/nrneurol.2010.146

14. Broderick JP, Brott TG, Duldner JE et al. Volume of intracerebral hemorrhage: a powerful and easy-to-use predictor of 30-day mortality. Stroke 1993; 24:987-3. https://doi.org/10.1161/01.STR.24.7.987

15. Brott T, Thalinger K, Hertzberg V: Hypertension as a risk factor for spontaneous intracerebral hemorrhage. Stroke 1986; 17:1078-1083. https://doi.org/10.1161/01.STR.17.6.1078

16. Wang X, Arima H, Al-Shahi Salman R et al. Clinical Prediction Algorithm (BRAIN) to Determine Risk of Hematoma Growth in Acute Intracerebral Hemorrhage. Stroke. 2015; 46:376–81. https://doi.org/10.1161/STROKEAHA.114.006910

17. Mohr JP, Caplan LR, Melski JW. The Harvard Cooperative Stroke Registry: a prospective registry. Neurology 1978; 28:754-62. https://doi.org/10.1212/WNL.28.8.754

18. Song EC, Chu K, Jeong SW. Hyperglycemia exacerbates brain edema and perihematomal cell death after intracerebral hemorrhage. Stroke 2002; 34:2215-20. https://doi.org/10.1161/01.STR.0000088060.83709.2C

19. Kaufmann HH. Treatment of deep spontaneous intracerebral hematomas: a review. Stroke 1993; 24: I101-6.

20. Kobayashi S, Sato A, Kageyama Yet al. Treatment of hypertensive cerebellar hemorrhage – surgical or conservative management? Neurosurgery 1994; 32:246-50. https://doi.org/10.1227/00006123-199402000-00006

21. Mendelow AD, Gregson BA, Fernandes HM et al. STICH investigators. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet. 2005; 365:387-97. https://doi.org/10.1016/S0140-6736(05)70233-6

22. Daverat P, Castel JP, Dartigues JF, Orgogozo JM. Death and functional outcome after spontaneous intracerebral hemorrhage. A prospective study of 166 cases using multivariate analysis. Stroke 1991; 22:1-6. https://doi.org/10.1161/01.STR.22.1.1

23. Nakamura T, Xi G, Hua Yet al. Intracerebral hemorrhage in mice: model characterization and application for genetically modified mice. J Cereb Blood Flow 2004; 24:487–95. https://doi.org/10.1097/00004647-200405000-00002

Acta Facultatis Medicae Naissensis

The Journal of Faculty of Medicine in Nis

Journal Information


Cite Score 2017: 0.27

SCImago Journal Rank (SJR) 2017: 0.140
Source Normalized Impact per Paper (SNIP) 2017: 0.240

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 271 226 14
PDF Downloads 87 77 7