Comparison of Spontaneous Intracerebral Hemorrhage Treatment in Germany Between 1999 and 2009

Abstract

Background and Purpose— The aim of our study was to examine surgical practice in the therapy of spontaneous intracerebral hemorrhage in Germany over a period of 10 years. Methods— In 1999 and 2009 a questionnaire with 10 different cases of spontaneous intracerebral hemorrhage was sent to all neurosurgical centers in Germany. It included a cranial CT as well as a case description. The question asked if a conservative or surgical procedure was most suitable. When choosing surgery, the participants could decide between large open approach or microsurgery as well as stereotactic aspiration or external ventricular drainage. Results— In 1999, 85 of 121 (70%) and in 2009 111 of 125 (89%) questionnaires could be evaluated. The results of the questionnaires from 1999 and 2009 showed no difference in the decision for or against a surgical procedure, except for a move toward conservative treatment in 1 patient with a massive spontaneous intracerebral hemorrhage. In 2 cases of isolated basal ganglia bleeding, a conservative approach was chosen by approximately 98% of the participants both in 1999 and in 2009. In all other cases of spontaneous intracerebral hemorrhage, in particular when the patient was in poor clinical condition, the decision was very heterogeneous. Conclusions— Despite new studies, there were no significant differences regarding the decision for or against a surgical procedure in 1999 and 2009. Although clearly unfavorable prognostic factors are known, many patients still undergo a surgical procedure. It appears that at least spontaneous intracerebral hemorrhage in the area of the basal ganglia is a unique domain of conservative treatment.

Five psychological mechanisms that might bias learning from neurosurgical complications: case discussions and a narrative review

“…This makes clinical decisions regarding these patients potentially heterogenous between neurosurgical departments as well as between individual neurosurgeons. 2 Ambiguity, also makes decision-making, including life and death decisions vulnerable to influence by different forms of unconscious cognitive and social biases 3,4,5 A similar ambiguity can of course also be present regarding the question whether perceived problems with hemostasis during the end of a procedure should be attributed to characteristics of the patient or characteristics of the neurosurgeon. This leaves the field open to two inter-related forms of largely unconscious cognitive biases that are often referred to as 'self-serving bias' and the 'actor-observer effect' respectively.…”

Comparison of epidemiological and clinical features between two chronological cohorts of patients with intracerebral hemorrhage

“…Some randomized controlled trials (RCTs) have been conducted to identify the main factors that affect the outcome of ICH, such as the early diagnosis [6], hemostatic treatment [7,8], acute anti-hypertensive treatment [9], hematoma removal [10,11], etc. Furthermore, within the last few decades, the incidence of ICH has increased and the mortality rate is still high in western developed countries [12][13][14][15][16]. The status in China, even in regional area, remains elusive.…”

Stereotactic Administration of Edaravone Ameliorates Collagenase‐Induced Intracerebral Hemorrhage in Rat

“…Hematoma during early ICH can directly compress brain tissue, which further leads to mechanical injury and additional secondary brain injury, as well as excitotoxic‐related neurological deterioration , inflammatory responses and neuronal cell death . Controversy remains regarding surgical procedures and conservative treatment paradigms with respect to clinical outcome and mortality rate . Edaravone, an effective free radical scavenger and antioxidant, can alleviate cerebral edema , and in the clinic, it has been widely used for treating ischemic stroke.…”