Surgery for primary supratentorial intracerebral haemorrhage

Prasad, Kameshwar; Mendelow, AD; Gregson, Barbara

doi:10.1002/14651858.cd000200.pub2

Cited by 109 publications

(57 citation statements)

References 25 publications

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“…2,3,9,10,12 Worst of all, there is no proven effective treatment for this disease other than supportive measures; clinical trials have consistently failed to identify a role for surgery in the treatment of ICH. 8,11,15,19,32 In 1999, a special writing committee appointed by the American Heart Association issued treatment guidelines for ICH based on 5 small randomized clinical trials of medical treatment and 4 small randomized clinical trials of surgery. 11 These guidelines were recently updated in 2007, incorporating the findings of 15 other recent controlled studies of ICH treatment.…”

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confidence: 99%

Recent trends in the treatment of spontaneous intracerebral hemorrhage: analysis of a nationwide inpatient database

Andaluz

Zuccarello

2009

JNS

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Object. Recently updated guidelines failed to reflect significant progress in the treatment of intracerebral hemorrhage (ICH). Using data from a nationwide hospital database, the authors identified recent trends in therapy and outcomes for ICH, as well as the effect of associated comorbidities and procedures, including surgery.Methods. Data from the Nationwide Inpatient Sample hospital discharge database (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality) for the period 1993-2005 was retrospectively reviewed. Multiple variables were categorized and subjected to statistical analysis for codes related to ICH from the International Classification of Diseases, 9th revision, Clinical Modification. Data linked by the Nationwide Inpatient Sample database to associated diagnoses and procedures were also retrieved and analyzed.Results. The number of discharges remained constant for ICH. The mortality rate remained unchanged at an average of 31.6%, whereas routine discharges (home) steadily declined by 25%, and discharges other than home doubled (p < 0.01). By the end of the study, length of hospital stay decreased by 30% (p < 0.01), and mean hospital charges steadily increased to more than twice the original figures. Arterial hypertension was the most frequently associated comorbidity. Seizures were associated with longer hospital stays and higher mean hospital charges. Craniotomy was associated with decreased mortality rates but also with worse outcomes and lower rates of patients discharged home (p < 0.01). No geographic differences in treatment and outcomes were noted.Conclusions. From 1993 to 2005, no significant progress in treatment and prevention of ICH was noted. There were no regional differences in the treatment and outcome of ICH. The role of surgery for ICH remains uncertain, and large-scale controlled studies are greatly needed to clarify this role. (DOI: 10.3171/2008.5.17559) Key Words

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Recent trends in the treatment of spontaneous intracerebral hemorrhage: analysis of a nationwide inpatient database

Andaluz

Zuccarello

2009

JNS

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“…De modo inverso un volumen mayor de 50-60 cc se asocia a un peor pronós-tico, y del reanálisis de los datos de Auer se concluyó que en el subgrupo de pacientes con hematomas de más de 50 cc la cirugía presentaba una tendencia a mejor evolución que el tratamiento médico 5,24,33 . Kanaya et al en una serie amplia de hematomas putaminales establecieron en 30 cc el umbral a partir del cual disminuye la mortalidad y mejora el pronóstico funcional respecto al tratamiento médico 16 , volumen límite también considerado por otros 3,28 .…”

Section: Discussionunclassified

Tratamiento quirúrgico de la hemorragia intracerebral espontánea: Parte I: Hemorragia supratentorial

Pérez-Núñez¹,

Lagares

Pascual

et al. 2008

Neurocirugía

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ResumenLa hemorragia intracerebral espontánea (HIE) constituye uno de los procesos ictales de mayor gravedad. A pesar de esto y de una elevada incidencia, su tratamiento médico no va mucho más allá de un papel de soporte vital y control médico de la hipertensión intracraneal, y las indicaciones del tratamiento quirúr-gico están pobremente basadas en evidencia científica.El objetivo del presente trabajo fue revisar las bases de la indicación quirúrgica en la HIE supratentorial.Encontramos 10 ensayos clínicos y 5 meta-análisis en lengua inglesa que analizaban la utilidad del tratamiento quirúrgico en esta patología. Aunque globalmente estos estudios no mostraron un beneficio significativo del tratamiento quirúrgico en el conjunto de pacientes con HIE supratentorial, existe un subgrupo de pacientes en los que parece que dicho tratamiento podría ser beneficioso.En la hemorragia intracerebral espontánea supratentorial las recomendaciones actuales indican que los pacientes jóvenes, con hematomas lobares cuyo volumen causa un deterioro del nivel de consciencia, deben ser intervenidos. En pacientes con hematomas putaminales que reúnen las mismas condiciones de edad y deterioro neurológico la cirugía podría mejorar la evolución, al menos en términos de supervivencia. Un grave deterioro neurológico con GCS<5, la localización talámica y la presencia de una situación basal o edad que impidan una adecuada recuperación funcional, son criterios considerados tradicionalmente contraindicación del tratamiento quirúrgico. Dada la ausencia de evidencia científica sólida en la que sustentar estas recomendaciones, la decisión terapéutica debe realizarse de manera individualizada y prestando atención al soporte sociofamiliar del paciente, que jugará un papel importante en la evolución del mismo a medio/largo plazo.PALABRAS CLAVE: Hemorragia intracerebral. Cirugía. Tratamiento. Surgical treatment for spontaneous intracerebral haemorrhage. Part I: Supratentorial haematomas SummarySpontaneous intracerebral haematoma (SICH) represents one the most severe subtypes of ictus. However, and despite a high incidence, medical treatment is almost limited to life support and to control intracranial hypertension and indications of surgical treatment are poorly defined.The aim of this paper was to review the evidence supporting surgical evacuation of SICH.Ten clinical trials and five meta-analyses studying the results of surgical treatment on this pathology were found on English literature. These studies considered all together, failed to show a significant benefit of surgical evacuation in patients with SICH considered as a whole. However, a subgroup of these patients has been considered to potentially present a better outcome after surgical treatment.Current recommendations on supratentorial intracerebral haemorrhage state that young patients with lobar haematomas causing deterioration on the level of consciousness should be operated on. Patients suffering from putaminal haematomas and fitting with the same criteria of age and neurological deterio...

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“…However, a pilot study using the STICH trial protocol (except that patients were treated within 4 hours of symptom onset) showed higher rates of re-bleeds and poor outcomes [105]. Overall, for craniotomy in general, a Cochrane review of 10 trials pooling 2059 patients showed a statistically significant result in favor of surgery when looking at death as an endpoint alone, and also when death or dependency at final follow-up were combined [106].…”

Section: Surgical Clot Evacuationmentioning

confidence: 99%