Factors Affecting Prognosis in Patients With Spontaneous Supratentorial Intracerebral Hemorrhage Under Medical and Surgical Treatment

Abstract

Spontaneous intracerebral hemorrhage (ICH) is a vascular brain disease that causes very high rates of death and disability. Whether surgical or medical treatment is more appropriate is controversial. The purpose of the study was to examine the morbidity and mortality rates of surgical and medical therapy and their differences in order to determine which patients should be operated. In our study, the authors selected randomly and evaluated retrospectively 49 patients who were operated in Haydarpaşa Numune Research and Education Hospital Neurosurgery Clinic and 51 patients who received medical therapy at Neurology Clinic for spontaneous supratentorial ICH between January 2007 and December 2011. The authors documented a detailed history of each patient featuring their neurological examination, Glasgow Coma Scale (GCS), Modified Rankin Disability Scale (MRDS), imaging, age, gender, and history of stroke, hypertension, diabetes mellitus, smoking and alcohol use, aspirin, or coumadin usage. As a result, the mortality rate found in our study was similar to previous studies (49%). Mortality of patients who underwent surgery (63%) found a higher rate of disability. This is because hematoma of the patients who were operated on larger volumes and diameters, GCS lower than and the higher MRDS scores, higher rates of herniation is connected. The authors concluded that very early operation does not create a difference in treatment between mortality rates. The authors observed that the most important factors for the prognosis of ICH patients whether operated or not are the GCS of patients at the time of arrival to the hospital and the nature of the hematoma.

A Nomogram Model for Predicting Prognosis in Spontaneous Intracerebral Hemorrhage Patients

“…More attention should be given to ICH patients with the abovementioned imaging characteristics to obtain a good prognosis. According to previous reports, intracranial hemorrhage rupture into the ventricle is a predictor of poor prognosis [26]. Our univariate analysis and multivariate analysis showed that the IVH relationship was an independent predictor of prognosis.…”

Multifactorial analysis of postoperative rebleeding in patients with spontaneous supratentorial intracerebral hemorrhage： a single-center experience

“…Hematoma volume is another important indicator of the severity of spontaneous ICH. Cerebral hemorrhage volume and level of consciousness are determinants of short-term prognosis [25][26][27][28] . Previous reviews have shown that minimally invasive surgery is appropriate for hematomas with a volume of 25-40 mL, while hematomas > 40 mL require other forms of treatment, such as craniotomy 1,29,30 .…”

“…For many years, the GCS score has been used as an important criterion for assessing the severity of acute traumatic brain injury, as it provides a comprehensive index of neurologic impairment of patients with craniocerebral injury. It is also one of the most important clinical indicators for determining the indications for surgery and predicting prognosis 25 . The GCS score has shown some correlation with rebleeding rate, especially in non-comatose patients and nonsurgical patients, and it correlates with various factors that in uence rebleeding in patients with hypertensive cerebral hemorrhage, such as patient age, blood pressure, blood glucose, and hematoma volume.…”

14-Day Mortality Predictive Factors in Surgically Treated Supratentorial Spontaneous Intracerebral Hemorrhage: A Retrospective Analysis of 44 Patients

“…[2], [5] Thus, sICH has been declared the world's third most common cause of death. [6] Various modalities of patient management, both conservatively and surgical, have been studied and continue to be developed to increase patient safety with intracerebral hemorrhage. [7] Surgery in sICH is aimed at removing clots while relieving tissue injury, decreasing local ischemia, and lowering intracranial pressure.…”