Prognostic factors of intracerebral hematomas surgical removal and role for treatment strategy

Abstract

Objective – to elaborate prognostic criteria of surgical treatment of patients with intracerebral hematomas.Materials and methods. Sixty nine patients with intracerebral hematomas were operated by craniotomy or craniectomy with encephalotomy in Lviv Emergency Hospital, 8th Lviv City Hospital and Chervonohrad Central City Hospital in 2013–2018. The results of radiological (computed tomography, cerebral angiography) and clinical examination (neurological status before and after surgery) of patients who were operated, with the use of Glasgo coma scale (GCS), Functional Outcome in Patients with Primary Intracerebral Hemorrhage (FUNC), Intracerebral Hemorrhage Score (ICH Score) scales were analyzed. Such parameters as the duration and type of surgery, size and location of ICH, the level of consciousness, and neurological deficit at admission and the time of surgery were determined. Patients were divided into two groups depending on the degree of brain midline shift on computed tomograms obtained at the time of hospitalization: group I (≤5 mm) – 18 patients, group II (>5 mm) – 51 patients. There were 22 women (31.9 %), 47 men (68.1 %). Twenty nine (42.0 %) patients died. The age of patients was as follows: 25–44 years – 9 (13.1 %), 45–60 years – 36 (52.2 %), 60–75 years – 21 (30.4 %), 75–90 years – 3 (4.3 %). Localization of intracerebral hematomas was as follows: subcortical – 15 (21.7 %), putaminal (lateral) – 36 (52.2 %), thalamic (medial) – 12 (17.4 %), cerebellar – 6 (8.7 %). Results. For the most part, surgical treatment of ICH required craniectomy with encephalotomy. When choosing method and timing of surgery, the data of brain CT scans (midline shift, size and location of ICH) were taken into account, based on which patients were divided into 2 groups. Expected recovery of operated patients was analyzed with the FUNC and ICH Score scales. It was determined that, taking into account the neurological status and CT scan data, patients from group 2 were operated 12.2 hours earlier than patients from group 1. Delay of surgery, when the condition of patients in group 2 worsened, led to the worsening in the 90-day functional independence level, but did not affect the 30-day mortality rate.Conclusions. Surgery by craniotomy or craniectomy with encephalotomy remains the method of choice to treat the intracerebral hematomas. Early computed diagnostics and appropriate treatment strategy provide improvement, better functional recovery of patients in postoperative period.