A randomized controlled study of operative versus nonoperative treatment for large spontaneous supratentorial intracerebral hemorrhage

Bhaskar, Mukesh Kumar; Kumar, Rakesh; Ojha, Bal Krishna; Singh, Sunil Kumar; Verma, Nishant; Verma, Rajesh; Chandra, Anil; Srivastava, Chhitij; Jaiswal, Manish; Jaiswal, Somil; Huliyappa, Harsha A.

doi:10.4103/neuroindia.ni_151_16

Cited by 17 publications

(23 citation statements)

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“…16 Quality of studies was low in 9 studies, 30,32,[34][35][36][38][39][40]45 and moderate in 8 studies. 33,37,[41][42][43][44]46,47 Only 4 studies were of high quality, 15,16,18,31 of which 2 investigated minimally invasive surgery (Fig 2). 18,31 The funnel plot suggested possible publication bias for smaller studies demonstrating results in favor of medical management (Fig 3).…”

Section: Resultsmentioning

confidence: 99%

Neurosurgical Intervention for Supratentorial Intracerebral Hemorrhage

Sondag

Schreuder

Boogaarts

et al. 2020

Annals of Neurology

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Objective The effect of surgical treatment for supratentorial spontaneous intracerebral hemorrhage (ICH) and whether it is modified by key baseline characteristics and timing remains uncertain. Methods We performed a systematic review and meta‐analysis of randomized controlled trials of surgical treatment of supratentorial spontaneous ICH aimed at clot removal. We searched MEDLINE, Embase, and Cochrane databases up to February 21, 2019. Primary outcome was good functional outcome at follow‐up; secondary outcomes were death and serious adverse events. We analyzed all types of surgery combined and minimally invasive approaches separately. We pooled risk ratios with 95% confidence intervals and assessed the modifying effect of age, Glasgow Coma Scale, hematoma volume, and timing of surgery with meta‐regression analysis. Results We included 21 studies with 4,145 patients; 4 (19%) were of the highest quality. Risk ratio of good functional outcome after any type of surgery was 1.40 (95% confidence interval [CI] = 1.22–1.60, I2 = 46%, 20 studies), and after minimally invasive surgery it was 1.47 (95% CI = 1.26–1.72, I2 = 47%, 12 studies). For death, the risk ratio for any type of surgery was 0.77 (95% CI = 0.68–0.85, I2 = 23%, 21 studies), and for minimally invasive surgery it was 0.68 (95% CI = 0.56–0.83, I2 = 14%, 13 studies). Serious adverse events were reported infrequently. Surgery seemed more effective when performed sooner after symptom onset (p = 0.04, 12 studies). Age, Glasgow Coma Scale, and hematoma volume did not modify the effect of surgery. Interpretation Surgical treatment of supratentorial spontaneous ICH may be beneficial, in particular with minimally invasive procedures and when performed soon after symptom onset. Further well‐designed randomized trials are needed to demonstrate whether (minimally invasive) surgery improves functional outcome after ICH and to determine the optimal time window of the treatment after symptom onset. ANN NEUROL 2020;88:239–250.

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Section: Resultsmentioning

confidence: 99%

Neurosurgical Intervention for Supratentorial Intracerebral Hemorrhage

Sondag

Schreuder

Boogaarts

et al. 2020

Annals of Neurology

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“…Rost et al12 concluded that ICH volumes are frequently used in clinical decision-making and categorized the volumes as <30 mL, 30–60 mL, and >60 mL. In Bhaskar’s study, the mortality rate at 3 months was found to be directly proportional to hematoma volume ( P =0.039); the mortality rates reported in this study were 56.4% among patients with hematoma volumes in the range of 31–60 mL, 81% for volumes in the range of 61–90 mL, and 100% for volumes >90 mL 13…”

Section: Discussionmentioning

confidence: 51%

“…Moreover, the Surgical Trial in Intracerebral Hemorrhage (STICH) studied 1,033 patients with SSICH and reported that there was no overall benefit of surgical intervention compared with nonsurgical management 4. However, in Mukesh’s study,13 the mortality rate at 3 months was significantly lower in the surgical group (61.8%) than in the conservative group (85.2%; P =0.043), and the mortality rate was significantly higher (80.5%) among patients with GCS scores of 4–8 compared with those with GCS scores of 9–14 (55%) among both the surgical and conservative treatment groups ( P =0.037). Furthermore, among patients with GCS scores of 4–8, the mortality rate of the surgical group (65.2%) was found to be significantly lower than that of the conservative therapy group (100%; P =0.005).…”

Section: Discussionmentioning

confidence: 99%

<p>Minimally invasive evacuation of spontaneous supratentorial intracerebral hemorrhage by transcranial neuroendoscopic approach</p>

Cai¹,

Guo²,

Li³

et al. 2019

NDT

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Objective Spontaneous supratentorial intracerebral hemorrhage (SSICH) is one of the deadliest diseases, and neuroendoscopic surgery (NE) is a minimally invasive and promising treatment that might improve the functional recovery of patients. This study analyzed patient’s experience with this treatment in terms of safety, efficacy, and surgical technique. Patients and methods Forty-two patients with SSICHs treated by transcranial neuroendoscopic approach were retrospectively reviewed from June 2016 to July 2018 in our department. Patients were classified into four groups according to the main location of the hematoma on CT scans: Group A (basal ganglia hemorrhage), Group B (subcortical hemorrhage), Group C (thalamic hemorrhage), and Group D (intraventricular hemorrhage [IVH]). The clinical data were collected, and the outcomes were analyzed. Results All procedures were successfully completed, and no patient died in the perioperative period. The average hematoma evacuation rate was 90.1%, and the highest hematoma evacuation rate was achieved in Group B which was 92.7%. No severe complications occurred, and the average GCS score improvement was 4.0 at discharge. Conclusion These data suggest that evacuation hemorrhage by neuroendoscopy might be an effective and safe approach for SSICH. For better efficiency of this treatment, some details needed to be emphasized, such as setting up a good working channel, using of suction and bipolar forceps accurately.

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“…nme, tüm dünyada mortalite ve morbiditenin en önde gelen nedenlerinden biridir (1,2). İnmelerin ikinci en yaygın sebebi olan ve %10-55 arasında sıklık bildirilen spontan (non-travmatik) İSH olguları, etkin tedavi şeması net bir şekilde ortaya konamamış, mortalitesi son derece yüksek (ilk bir aylık ölüm oranı %30-50), gerek yüksek mortalite ve gerekse kalıcı morbidite nedeniyle toplumda önemli sosyo-ekonomik etkilere neden olan olgulardır (2)(3)(4)(5). İSH ile ilgili çalışmalara literatürde, diğer inme ve intrakranial kanama nedenlerine göre daha az rastlanmaktadır (6).…”

Section: İunclassified

“…Hemorajik inmelerin ölüm oranı iskemik inmelere göre daha yüksektir ve mortal olmayan olgularda bile ciddi sekeller kalabilir. Hastaların sadece %20'si intraserebral kanamadan altı ay sonra kimseye ihtiyaç duymadan hayatını sürdürebilmektedir (5,8).…”

Section: İunclassified

Spontan İntraserebral Hematomların Cerrahi Tedavisi

Dolgun¹,

Hanalıoğlu²,

Gürses³

et al. 2020

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Bu çalışmanın amacı tüm inmelerin yaklaşık beşte birini oluşturan ve yüksek mortalite ve morbidite oranlarına sahip intraserebral hematomların (İSH) klinik-radyolojik özellikleri, cerrahi tedavi endikasyonları ve sonuçlarını geniş bir klinik seriden elde edilen tecrübeler ışığında analiz etmektir. Gereç ve Yöntem: Çalışmaya Ocak 2006 -Aralık 2017 tarihleri arasında, spontan İSH nedeniyle kliniğimizde ameliyat edilen 18 yaş üstü tüm hastalar dahil edildi. Hastaların epikriz kayıtları, radyolojik görüntüleri, ameliyat notları ve takip sonuçları retrospektif olarak incelendi. Yaş, cinsiyet, risk faktörü varlığı, başvuru anındaki nörolojik durum, hematomun lokalizasyonu ve hacmi, radyolojik özellikler, cerrahi teknik, postoperatif nörolojik sonuçlar, re-operasyon ve takip sonuçlarını içeren veriler toplandı. Bulgular: Spontan İSH nedeniyle toplam 88 hasta (30 kadın (%34,1), 58 erkek (%65,9)) opere edildi. Tanı anındaki yaş ortalaması 59,3±20,1 yıl (aralık: 18-97, ortanca: 62) olarak hesaplandı. Başlıca başvuru semptom ve bulguları bilinç kaybı, bulantı-kusma, şiddetli baş ağrısı, ajitasyon, nöbet ve kuvvet kaybı (hemipleji) idi. Hastalar semptomların ortaya çıkışını takiben 20 dakika ile 5 saat arasında değişen sürelerde acile başvurdu. 74 hastaya (%84,1) dekompresif hemikraniyektomi + hematom aspirasyonu, 14 hastaya (%15,9) kraniyotomi + hematom aspirasyonu uygulandı. Ventriküle açılmış kanaması olan 58 hastanın (%65,9) 22'sinde (%25) izlemde gelişen hidrosefali nedeniyle eksternal ventriküler drenaj (EVD) ihtiyacı oldu. Antiagregan/antikoagülan kullanımı olan 37 (%42) hastanı 5'inde (%5,7) tekrarlayan kanama veya hematom boyutunda artış gözlendi. Hastaların 47'si (%53,4) kanamadan sonraki ilk 30 gün içinde hayatını kaybetti. GKS'si 8 ve daha düşük, kan hacmi ise 70 cm3'ün üzerinde olan hastalarda ise bu dönemde ölüm oranı %88 olarak bulundu. Sonuç: Antiagregan/antikoagülan kullanım öyküsü bulunan, yaşlı, hipertansif hastalarda daha yaygın görülen İSH mortalite ve morbiditesi oldukça yüksek bir hastalıktır. İleri yaş, çoklu yandaş hastalık varlığı, büyük hematom hacmi, başvuru anındaki düşük Glasgow koma skalası kötü prognoz ile ilişkilidir. Erken ve etkili cerrahi tedavi özellikle genç, yandaş hastalığı olmayan, nörolojik durumu nisbeten iyi veya ani kötüleşen hastalarda hayat kurtarıcı olabilmektedir.

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A randomized controlled study of operative versus nonoperative treatment for large spontaneous supratentorial intracerebral hemorrhage

Abstract: In patients with SSICH, mortality was found to be significantly associated with the treatment arm and the results were in favour of SM among the patients presenting with GCS 4-8, hematoma volume 31-60 ml, midline shift of more than 5 mm, and intraventricular extension of the hematoma.

Cited by 17 publications

References 1 publication

Neurosurgical Intervention for Supratentorial Intracerebral Hemorrhage

Neurosurgical Intervention for Supratentorial Intracerebral Hemorrhage

<p>Minimally invasive evacuation of spontaneous supratentorial intracerebral hemorrhage by transcranial neuroendoscopic approach</p>

Spontan İntraserebral Hematomların Cerrahi Tedavisi

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