1887
Volume 2021, Issue 3
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Background: Intracerebral hemorrhage (ICH) remains a devastating disease with high morbidity and mortality. The mortality rate ranges from 40% at 1 month to 54% at 1 year, and only 12%–39% achieve good outcomes and functional independence. The current management guidelines for spontaneous supratentorial ICH are still controversial.

Objective: Patients who presented with ICH and underwent craniotomy with hematoma evacuation or minimal procedures from January 2016 to May 2020 were included in the analysis. Several clinical, radiological, and surgical variables were collected to identify the variables most likely related to lower mortality and better functional outcomes.

Results: A total of 87 patients presented with HMC with ICH from January 2016 to May 2020.

The mean age was 44.7 (42.2–47.2) years. There were 76 male (87.4%)/11 female (12.6%) patients, which reflect the population distribution in Qatar, which is mainly male predominant. Although Qatar is mainly a Middle-Eastern country, the ethnic distribution of patients was mainly of South Asian and Indian (60.9%) and Far-Eastern (20.7%) ethnicities because of diversity. The mean baseline Glasgow coma scale (GCS) was 8.2+/ − 3.7. The mean baseline functional independence measure (FIM) score was 59.4+/ − 36.7. Most hematomas were located in the basal ganglia (79.3%%). Baseline characteristics based on long-term outcomes are summarized in Table 1. The following variables were correlated with poor outcome: low GCS on postoperative day 1 (P = 0.06), low FIM score (P = 0.006), ICH location (P = 0.04), distance of the closest point to the surface (P = 0.009), and presence of uncal herniation (P = 0.04). The baseline characteristics based on mortality are outlined in Table 2. The following variables were correlated with mortality: diabetes mellitus (P = 0.02), baseline GCS (P = 0.04), GCS on postoperative day 1 (P = 0.002), unequal pupils (P = 0.05), and postoperative midline shift (P = 0.001).

Table 1

Baseline characteristics based on long-term outcomes

Table 2

Baseline characteristics based on mortality

Conclusion: The preoperative clinical neurological status as well as mass effect (uncal herniation and midline shift) can be determinants of functional outcome and mortality. A deeper hematoma may result in poor functional outcome because of more surgical damage in functional brain tissues. Thus, the goal of surgery in spontaneous supratentorial ICH is to reduce mortality, but no evidence support that it can improve functional outcome. Although our findings are interesting, more prospective studies with a larger sample size are needed to confirm our results.

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2021-10-18
2021-12-02
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References

  1. Hemphill JC, 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015; 46:(7):2032–60. Epub 2015/05/30. doi: 10.1161/str.0000000000000069. PubMed PMID: 26022637.
    [Google Scholar]
  2. Aguilar MI, Brott TG. Update in intracerebral hemorrhage. Neurohospitalist. 2011; 2011:(1)148–59. doi: 10.1177/1941875211409050. PubMed PMID: 23983850.
    [Google Scholar]
  3. de Oliveira Manoel AL. Surgery for spontaneous intracerebral hemorrhage. Critical Care. 2020; 2020:(24)45. doi: 10.1186/s13054-020-2749-2. PMID: 32033578.
    [Google Scholar]
  4. Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, et al. 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 (London, England). 2005; 365:(9457):387–97. Epub 2005/02/01. doi: 10.1016/s0140-6736(05)17826-x. PubMed PMID: 15680453.
    [Google Scholar]
  5. Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. The Lancet. 2013; 2013:(382)397–408. doi: 10.1016/S0140-6736(13)60986-1. PMID: 23726393.
    [Google Scholar]
  6. Esquenazi Y, Savitz SI, El Khoury R, McIntosh MA, Grotta JC, Tandon N. Decompressive hemicraniectomy with or without clot evacuation for large spontaneous supratentorial intracerebral hemorrhages. Clinical neurology and neurosurgery. 2015;128:117–22. Epub 2014/12/17. doi: 10.1016/j.clineuro.2014.11.015. PubMed PMID: 25496934.
    [Google Scholar]
  7. Hanley DF, Thompson RE, Muschelli J, Rosenblum M, McBee N, Lane K, et al. Safety and efficacy of minimally invasive surgery plus alteplase in intracerebral haemorrhage evacuation (MISTIE): a randomised, controlled, open-label, phase 2 trial. Lancet Neurol. 2016; 2016:(15)1228–37. Epub 2016/10/11. doi: 10.1016/S1474-4422(16)30234-4. PubMed PMID: 27751554.
    [Google Scholar]
  8. Hanley DF, Thompson RE, Rosenblum M, Yenokyan G, Lane K, McBee N, et al. Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial. Lancet (London, England). 2019; 393:(10175):1021–32. Epub 2019/02/12. doi: 10.1016/s0140-6736(19)30195-3. PubMed PMID: 30739747; PubMed Central PMCID: PMCPMC6894906.
    [Google Scholar]
  9. Morgan T, Zuccarello M, Narayan R, Keyl P, Lane K, Hanley D. Preliminary findings of the minimally-invasive surgery plus rtPA for intracerebral hemorrhage evacuation (MISTIE) clinical trial. Acta neurochirurgica Supplement. 2008;105:147–51. Epub 2008/12/11. doi: 10.1007/978-3-211-09469-3_30. PubMed PMID: 19066101.
    [Google Scholar]
  10. Naff N, Williams MA, Keyl PM, Tuhrim S, Bullock MR, Mayer SA, et al. Low-dose recombinant tissue-type plasminogen activator enhances clot resolution in brain hemorrhage: the intraventricular hemorrhage thrombolysis trial. Stroke. 2011; 2011:(42)3009–16. Epub 2011/08/27. doi: 10.1161/strokeaha.110.610949. PubMed PMID: 21868730; PubMed Central PMCID: PMCPMC3356690.
    [Google Scholar]
  11. Newell DW, Shah MM, Wilcox R, Hansmann DR, Melnychuk E, Muschelli J, et al. Minimally invasive evacuation of spontaneous intracerebral hemorrhage using sonothrombolysis. Journal of neurosurgery. 2011; 2011:(115)592–601. Epub 2011/06/15. doi: 10.3171/2011.5.Jns10505. PubMed PMID: 21663412; PubMed Central PMCID: PMCPMC3785332.
    [Google Scholar]
  12. Gonzales NR, Shah J, Sangha N, Sosa L, Martinez R, Shen L, et al. Design of a prospective, dose-escalation study evaluating the Safety of Pioglitazone for Hematoma Resolution in Intracerebral Hemorrhage (SHRINC). International journal of stroke: official journal of the International Stroke Society. 2013; 2013:(8)388–96. Epub 2012/02/22. doi: 10.1111/j.1747-4949.2011.00761.x. PubMed PMID: 22340518.
    [Google Scholar]
  13. Kim DB, Park SK, Moon BH, Cho BR, Jang DK, Jang KS. Comparison of craniotomy and decompressive craniectomy in large supratentorial intracerebral hemorrhage. Journal of clinical neuroscience: official journal of the Neurosurgical Society of Australasia. 2018;50:208–13. Epub 2018/02/13. doi: 10.1016/j.jocn.2018.01.066. PubMed PMID: 29428269.
    [Google Scholar]
  14. Keep RF, Xi G, Hua Y, Hoff JT. The Deleterious or Beneficial Effects of Different Agents in Intracerebral Hemorrhage. Stroke. 2005; 2005:(36)1594–6. doi: doi:10.1161/01.STR.0000170701.41507.e1. PMID: 15933250.
    [Google Scholar]
  15. Xi G, Keep RF, Hoff JT. Mechanisms of brain injury after intracerebral haemorrhage. The Lancet Neurology. 2006; 2006:(5)53–63. Epub 2005/12/20. doi: 10.1016/s1474-4422(05)70283-0. PubMed PMID: 16361023.
    [Google Scholar]
  16. Scaggiante J, Zhang X, Mocco J, Kellner CP. Minimally Invasive Surgery for Intracerebral Hemorrhage. Stroke. 2018; 2018:(49)2612–20. Epub 2018/10/26. doi: 10.1161/strokeaha.118.020688. PubMed PMID: 30355183.
    [Google Scholar]
  17. Kellner CP, Chartrain AG, Nistal DA, Scaggiante J, Hom D, Ghatan S, et al. The Stereotactic Intracerebral Hemorrhage Underwater Blood Aspiration (SCUBA) technique for minimally invasive endoscopic intracerebral hemorrhage evacuation. Journal of NeuroInterventional Surgery. 2018; 2018:(10)771–6. doi: 10.1136/neurintsurg-2017-013719. PMID: 29572265.
    [Google Scholar]
  18. Fogelholm R, Murros K, Rissanen A, Avikainen S. Admission blood glucose and short term survival in primary intracerebral haemorrhage: a population based study. Journal of neurology, neurosurgery, and psychiatry. 2005; 2005:(76)349–53. Epub 2005/02/18. doi: 10.1136/jnnp.2003.034819. PubMed PMID: 15716524; PubMed Central PMCID: PMCPMC1739544.
    [Google Scholar]
  19. Kimura K, Iguchi Y, Inoue T, Shibazaki K, Matsumoto N, Kobayashi K, et al. Hyperglycemia independently increases the risk of early death in acute spontaneous intracerebral hemorrhage. Journal of the neurological sciences. 2007; 255:(1-2):90–4. Epub 2007/03/14. doi: 10.1016/j.jns.2007.02.005. PubMed PMID: 17350046.
    [Google Scholar]
  20. Mendelow AD. Surgical Craniotomy for Intracerebral Haemorrhage. Frontiers of neurology and neuroscience. 2015;37:148–54. Epub 2015/11/21. doi: 10.1159/000437119. PubMed PMID: 26588582.
    [Google Scholar]
  21. Gregson BA, Broderick JP, Auer LM, Batjer H, Chen XC, Juvela S, et al. Individual patient data subgroup meta-analysis of surgery for spontaneous supratentorial intracerebral hemorrhage. Stroke. 2012; 2012:(43)1496–504. Epub 2012/04/19. doi: 10.1161/strokeaha.111.640284. PubMed PMID: 22511006; PubMed Central PMCID: PMCPMC3419479.
    [Google Scholar]
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