Surgical Management of Spontaneous Supratentorial Intracerebral Hemorrhage
Keywords:
spontaneous supratentorial intracerebral hematoma, deep seated bleed, superficial bleed, presenting Glasgow Coma Scale.Abstract
Objective: Spontaneous supratentorial intracerebral hemorrhage has the highest morbidity and mortality of all stroke subtypes, and the role of surgery remains controversial. A prospective study was conducted to evaluate the role of surgery in patients with spontaneous supratentorial intracerebral hemorrhage and to identify the predictors of outcome after surgery. Study Design: Prospective, retrospective and observational study. Materials and Methods: This study was conducted at the department of Neurosurgery PGMI / AMC / LGH Lahore during a period of 10 months from March 2013 to December 2013. Adult patients in whom surgical evacuation of spontaneous supratentorial intracerebral hematoma was carried out were included in the study. Age / Sex, presenting Glasgow Coma Scale (GCS) and the volume and site of hematoma was noted. The outcome of the patients was categorized according to the Glasgow Outcome Scale.
Results: Twenty six adult patients meeting the inclusion criteria were included in the study. Twenty out of the 26 patients died and the mortality was 77%. All the 17 patients with deep seated bleed had a poor outcome (dead or disabled). 1 of the 9 patients with superficial bleeds had a favourable outcome. The mortality of patients with GCS ? 8 was 87.5% compared to a mortality of 60% for patients with GCS ? 9. Best outcome was seen in patients with GCS ? 9 and a superficial bleed with 3 (75%) of the four patients surviving and 1 (25%) having a favourable outcome. The volume of the Intracerebral hemorrhage (ICH) did not effect the outcome. Conclusion: Deep seated bleeds do not benefit from surgical evacuation of hematoma. Improved outcome can be anticipated in patients presenting with superficial hemorrhages and GCS ? 9.
References
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