Outcome Evaluation of Surgical Versus Conservative Treatment of Spontaneous Non- Traumatic Supratentorial Intracerebral Hemorrhage
Ahmed Esmael *
Department of Neurology, Mansoura University, Mansoura, Egypt
Mohamed Elsherif
Department of Neurology, Mansoura University, Mansoura, Egypt
Mohamed Elsayed
Department of Neurology, Mansoura University, Mansoura, Egypt
Mohamed State
Department of Neurosurgery, Mansoura University, Mansoura, Egypt
*Author to whom correspondence should be addressed.
Abstract
Background: Spontaneous supratentorial intracerebral hemorrhage (SSICH) has the greatest morbidity and fatality of all cerebral strokes, moreover the contribution of surgery stays contradictory. Early surgery to restrict the mechanical compression of the brain and the toxic impacts of blood maybe reduce damage.
Aim: To compare the outcome and efficacy of surgical evacuation of intracerebral hemorrhage (ICH) with the conservative medical treatment in cases of SSICH.
Materials and Methods: Fifty patients with SSICH was recruited to surgical or best medical treatment. Twenty-five patients experienced surgical evacuation whereas the other twenty-five were provided with conservative medical treatment. A history and neurological examination, including an assessment by Glasgow Coma Scale (GCS) and by the National Institutes of Health Stroke Scale (NIHSS), were obtained at the time of admission. Primary outcome (death or disability) using the extended Glasgow outcome scale (GOS) was 6 months after the onset. Secondary outcomes included mortality, the Barthel index (BI), and the modified Rankin scale (mRS).
Results: There were no statistically significant differences in GOS, GCS or NIHSS after one month of treatment. The mortality rate at 6 months for the early surgery group was 10 patients (40%) and the conservative group was 8 patients (32%) without statistically significant (P = 0.556). The secondary outcome by mRS and by BI was statistically significant in cases of the conservative group in comparison with cases of the surgical group (P > 0.05).
Conclusions: We conclude that there is no statistically significant difference in outcome between surgical and medical management of primary ICH. Patients with superficial hematomas might benefit from surgery. While, patients with GCS of ≤ 8 surgical evacuations should be avoided especially if the hematoma volume of ≥ 50 cm.
Keywords: Spontaneous intracerebral hemorrhage, surgical treatment, conservative management, GCS, GOS, NIHSS