Outcome of surgical evacuation of spontaneous supratentorial Intra cerebral hemorrhage (ICH)

Abstract

Background: Spontaneous, nontraumatic intracerebral hemorrhage (ICH) remains a significant cause of morbidity and mortality throughout the world. Although ICH has traditionally lagged behind ischemic stroke and aneurysmal subarachnoid hemorrhage in terms of evidence from clinical trials to guide management, the past decade has seen a dramatic increase in studies of ICH intervention. The aim of the present study was to evaluate the survival and functional outcome after surgical evacuation of spontaneous supratentorial intra cerebral hemorrhage and factors affecting prognosis. Methods: This is a prospective study for 50 consecutive patients admitted to neurosurgery department in Benha university Hospital suffering from spontaneous intra cerebral hemorrhage (ICH) in ER where examination was done including the general examination, neurological and other systems. Initial CT brain scan was done on admission by evaluation of size of hematoma, site , midline shift , presence of intra ventricular extention. Results: According to Mortality rate, 10 (20%) patients died within average of 7.5 days after surgery ranged between 0 to 13 days . their initial GCS before surgery was 5 in four cases and 6 in 6 cases which worsen after surgery. Survived cases needed average of 2.92± 1.03 days to be fully conscious ranged between 2 to 5 days. mRS distribution in all studied group after 6 months of surgery was varied between 0 to 6 as 0 grade means no residual symptoms in 2 (4%) patient while 4 (8%) patients showed grade 1 no significant disability, 10 (20%) patients showed grade 2 slight disability, 20 (40%) patients showed grade 3 moderate disability and 10 (20%) showed grade 6 which means dead cases. There was statistically significant difference between Mean GCS before and after surgery (p = < .0001) as it was 9.04 and improved to 11.56 before leaving hospital. The mean mRS after surgery and before leaving the hospital was 3.72 ± 0.91 ranged between 1 to 5 while after 6 months the mean improved to 3.2 after 6 months with a statistically significant difference (p = 0.0013). Conclusion: Craniotomy and evacuation of spontaneous supratentorial ICH in patients with good premorbid status and moderate to good GCS even with big sized hematoma (more than 50 ml) have better long-term functional outcome. A combination of surgery and neurocritical care can result in favorable clinical outcome, regardless of ICH size or location.