Retrospective analysis of surgical management for spontaneous basal ganglia haemorrhage and outcome: A tertiary institute experience

Abstract

Background: Spontaneous intracranial haemorrhage (ICH) is the most severe type of stroke with high mortality rates. This entity accounts for 17 to 33% of all strokes and is associated with a higher mortality rate. Approximately, 35–50% of patients with ICH die within the 30 days after event. Long-term survivors are often remaining with permanent deficits, with up to 75% suffering permanent disability and only 12% to 39% of the survivors have favourable outcomes. Several studies aiming to explore the efficacy of surgery for patients with ICH have been carried out. However, the results were inconclusive. To provide evidence for clinical practice, here we present a retrospective study to explore the effect of surgery for patients with spontaneous basal ganglia haemorrhage. Methods: The present study was conducted in the Neurosurgery Department of a tertiary care hospital in the Northern part of India from January 2018 to March 2020. Sixty-one patients aged between 20-70 years of basal ganglia haemorrhage who presented within 24 hours of ictus and operated were included in this study. Results: A total of 61 patients underwent surgical intervention consisting of 49 (80%) males and 12 (20%) females. Their age varied from 27 to 70 with mean age ± SD 51.93 ± 13.19 years. Thirty-six patients were ≥ 50 years of age, out of which 72% patients had unfavourable outcomes (GOS 1-3) and 28% had favourable outcome (GOS 4-5). There were 31 patients with GCS 5-8. Most patients (81%) had GOS 1-3(at the time of discharge). Out of 25 patients with GCS 9-12; 64% had GOS 4-5. The patients with volume of haematoma 40-60 ml, 82% patients had GOS 4-5. The patients with midline shift > 5 mm; 78% patients had GOS 1-3. Patients with midline shift < 5 mm; 82% had GOS 4-5 (P=0.005). The mean hospital stays of unfavourable outcomes group was 28.71 ± 10.25 days and of favourable outcomes group was 22.07 ± 6.32 days (0.000). Conclusions: Early surgery (within 6 hours) along with multi-modality medical management has definite positive role in the outcome of patients with spontaneous basal ganglionic haemorrhage. Patients ≥ 50 years, signs of brain herniation, volume of haematoma ≥ 60ml, hydrocephalic dilatation due the intraventricular haemorrhage, midline shift > 5 mm, and GCS ≤ 8 at presentation had poor prognosis.