Role of surgical management of spontaneous intracerebral hemorrhage

Abstract EN

Background : spontaneous Intracerebral hemorrhage (ICH) causes 10% to 15% of strokes, with a 30- day mortality rate of 35 % to 52 %.

Treatment of primary spontaneous intracerebral hemorrhage (ICH) is still controversial.

The aim of this work is the estimation of efficacy of surgical evacuation of spontaneous intracerebral hemorrhage (ICH).

Methods : A prospective randomized study of craniotomy and hematoma removal vs.

best medical management was performed in 54 patients with primary SICH.

Principal eligibility criterion was the presence of neurologic impairment associated with a spontaneous sub cortical or putaminal hemorrhage bigger than 30 mL.

Outcomes were assessed at 6 months post ictus.

Results: Analysis of outcome revealed a significantly higher percentage of good functional outcomes for the surgical patients, compared with those of the conservative group (33 % and 9 %, respectively).

By contrast, the mortality rates between operated and conservatively managed patients did not differ significantly.

The main prognostic variables were the age of the patient, hematoma volume, and location.

Stratifications of these parameters and analysis showed that the positive effect of surgery on the quality of survival was statistically not valid for patients with GCS scores lower than 8 or ICH volumes 80 mL or higher at the time of enrollment.

Conclusions : the study demonstrates that patients with ICH that surgically treated showed better functional results than conservatively treated group.

However, surgical treatment of ICH failed to improve the survival rates, as compared with medical management.