Surgical treatment for intracerebral hemorrhage (STICH)

Morgenstern, Lewis B.; Frankowski, Ralph F.; Shedden, Peter M.; Pasteur, W.; Grotta, James C.

doi:10.1212/wnl.51.5.1359

Cited by 273 publications

(164 citation statements)

References 9 publications

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“…To date, there are nine prospective randomized controlled studies in which surgical and medical management of SICH has been compared. 6,9,27,61,84,89,90,120,138 Overall, these studies fail to demonstrate a superiority of either medical or surgical management. The results are also limited by considerable methodological differences among the trials.…”

Section: Surgical Treatmentmentioning

confidence: 99%

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Spontaneous intracerebral hemorrhage: a review

Fewel¹,

Thompson²,

Hoff³

2003

FOC

143

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Spontaneous intracerebral hemorrhage (SICH) is a blood clot that arises in the brain parenchyma in the absence of trauma or surgery. This entity accounts for 10 to 15% of all strokes and is associated with a higher mortality rate than either ischemic stroke or subarachnoid hemorrhage. Common causes include hypertension, amyloid angiopathy, coagulopathy, vascular anomalies, tumors, and various drugs. Hypertension, however, remains the single greatest modifiable risk factor for SICH. Computerized tomography scanning is the initial diagnostic modality of choice in SICH, and angiography should be considered in all cases except those involving older patients with preexisting hypertension in thalamic, putaminal, or cerebellar hemorrhage. Medical management includes venous thrombosis prophylaxis, gastric cytoprotection, and aggressive rehabilitation. Anticonvulsant agents should be prescribed in supratentorial SICH, whereas the management of hypertension is controversial. To date, nine prospective randomized controlled studies have been conducted to compare surgical and medical management of SICH. Although definitive evidence favoring surgical intervention is lacking, there is good theoretical rationale for early surgical intervention. Surgery should be considered in patients with moderate to large lobar or basal ganglia hemorrhages and those suffering progressive neurological deterioration. Elderly patients in whom the Glasgow Coma Scale score is less than 5, those with brainstem hemorrhages, and those with small hemorrhages do not typically benefit from surgery. Patients with cerebellar hemorrhages larger than 3 cm, those with brainstem compression and hydrocephalus, or those exhibiting neurological deterioration should undergo surgical evacuation of the clot. It is hoped that the forthcoming results of the International Surgical Trial in IntraCerebral Hemorrhage will help formulate evidence-based recommendations regarding the role of surgery in SICH.

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Section: Surgical Treatmentmentioning

confidence: 99%

“…Morganstern, et al, 90 prospectively randomized 34 patients within 12 hours of onset. They reported a modest benefit in 6-month mortality rates in patients treated with craniotomy (19%) compared with medical therapy (24%).…”

Section: Neurosurg Focus / Volume 15 / October 2003mentioning

confidence: 99%

Spontaneous intracerebral hemorrhage: a review

Fewel¹,

Thompson²,

Hoff³

2003

FOC

143

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“…We found that smaller bleeds are better managed conservatively, while optimal management of moderate and large bleeds is inconclusive and there was no difference in the outcome at the end of three months. Generally patients with significant midline shift, acute hydrocephalus and deteriorating neurological status will require surgical evacuation [12][13][14][15], however the guidelines are clear for cerebellar haematoma [20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

“…The lack of consensus for the treatment of SICH has led to great variation in surgical and medical management [11][12][13]. Guidelines based on scant data from few randomised and many nonrandomised trials are uncertain at best [10].…”

Section: S Pontaneous Intracerebral Haemorrhage (Sich) Ismentioning

confidence: 99%

“…The neurological status at the initial presentation and the interval between onset and therapeutic intervention contributes to the prognosis [9]. Computed tomography (CT) scan (level one evidence and grade A recommendation) for the initial assessement and digital substraction angiography (DSA) to establish or rule out aneurysm/arteriovenous malformations are the investigations of choice [10].The lack of consensus for the treatment of SICH has led to great variation in surgical and medical management [11][12][13]. Guidelines based on scant data from few randomised and many nonrandomised trials are uncertain at best [10].…”

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Management of Spontaneous Intracerebral Haemorrhage

Swamy¹

2007

Medical Journal Armed Forces India

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Original Articlecare hospital, were included in the study. Glasgow coma scale (GCS) and the initial blood pressure were recorded at admission and after six hours. All the patients were evaluated with CT scan to assess the size, shape, location and volume of haematoma [17]. Based on the volume of the clot the bleed was grouped as small (<20 cc), moderate (21-40 cc) and large (>40 cc). Patients were also subjected to DSA CT angiography to rule out AVM/aneurysm and magnetic resonance imaging (MRI) to rule out tumour bleed. CT scan was repeated after six hours and on third day of admission in case of clinical deterioration.The criteria for surgical management in supratentorial SICH were patients less than 60 years of age, progressive neurological deficit, GCS of more than five, clot more than 40cc in volume, mass effect on CT scan and deterioration of neurological status while on conservative treatment. The medical management criteria were patients more than 60 years of age, GCS of five or less, clot less than 40 cc in size, brain stem extension and associated medical disorders.The criteria for surgical management in infratentorial SICH were patients with clot size of more than three centimeter in diameter, associated hydrocephalus, obliteration of brainstem cisterns and deterioration of neurological status. The medical management criteria were patients with clot size of less than three centimeter in diameter and GCS of less than five.Open craniotomy was used for evacuating the blood clot for treatment by surgical mode, while those conservatively managed were treated by decongestants.The patients were followed up for one month and after three months of discharge. The outcome was assessed based on Glasgow outcome scale at discharge, one month and three months after discharge. Introduction S pontaneous intracerebral haemorrhage (SICH) isresponsible for 10-15% of the acute stroke [1][2][3]. The common causes of SICH are hypertension, aneurysm, arteriovenous malformation (AVM), coagulopathies and vasculopathies [4][5][6]. Hypertensive bleed mainly occurs in putamen, near ruptured aneurismal site with or without subarachanoid haemorrhage/ventricular extension and at the site of AVM, while bleeding due to angiopathy is usually lobar [7,8]. The neurological status at the initial presentation and the interval between onset and therapeutic intervention contributes to the prognosis [9]. Computed tomography (CT) scan (level one evidence and grade A recommendation) for the initial assessement and digital substraction angiography (DSA) to establish or rule out aneurysm/arteriovenous malformations are the investigations of choice [10].The lack of consensus for the treatment of SICH has led to great variation in surgical and medical management [11][12][13]. Guidelines based on scant data from few randomised and many nonrandomised trials are uncertain at best [10]. All the studies emphasise on early evacuation of clot in case surgery is chosen as the treatment option [14][15][16]. This observational study aimed at identifying appro...

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