Favorable clinical outcome following surgical evacuation of deep-seated and lobar supratentorial intracerebral hemorrhage : a retrospective single-center analysis of 123 cases
Hessington, Amel ; Tsitsopoulos, Parmenion P. ; Fahlström, Andreas and Marklund, Niklas LU
(2018)
In Acta Neurochirurgica
160(9).
p.1737-1747
- Abstract
Background: In spontaneous supratentorial intracerebral hemorrhage (ICH), the role of surgical treatment remains controversial, particularly in deep-seated ICHs. We hypothesized that early mortality and long-term functional outcome differ between patients with surgically treated lobar and deep-seated ICH. Method: Patients who underwent craniotomy for ICH evacuation from 2009 to 2015 were retrospectively evaluated and categorized into two subgroups: lobar and deep-seated ICH. The modified Rankin Scale (mRS) was used to evaluate long-term functional outcome. Result: Of the 123 patients operated for ICH, 49.6% (n = 61) had lobar and 50.4% (n = 62) deep-seated ICH. At long-term follow-up (mean 4.2 years), 25 patients (20.3%) were dead,... (More)
Background: In spontaneous supratentorial intracerebral hemorrhage (ICH), the role of surgical treatment remains controversial, particularly in deep-seated ICHs. We hypothesized that early mortality and long-term functional outcome differ between patients with surgically treated lobar and deep-seated ICH. Method: Patients who underwent craniotomy for ICH evacuation from 2009 to 2015 were retrospectively evaluated and categorized into two subgroups: lobar and deep-seated ICH. The modified Rankin Scale (mRS) was used to evaluate long-term functional outcome. Result: Of the 123 patients operated for ICH, 49.6% (n = 61) had lobar and 50.4% (n = 62) deep-seated ICH. At long-term follow-up (mean 4.2 years), 25 patients (20.3%) were dead, while 51.0% of survivors had a favorable outcome (mRS score ≤ 3). Overall mortality was 13.0% at 30 days and 17.9% at 6 months post-ictus, not influenced by ICH location. Mortality was higher in patients ≥ 65 years old (p = 0.020). The deep-seated group had higher incidence and extent of intraventricular extension, younger age (52.6 ± 9.0 years vs. 58.5 ± 9.8 years; p < 0.05), more frequently pupillary abnormalities, and longer neurocritical care stay (p < 0.05). The proportion of patients with good outcome was 48.0% in deep-seated vs. 54.1% in lobar ICH (p = 0.552). In lobar ICH, independent predictors of long-term outcome were age, hemorrhage volume, preoperative level of consciousness, and pupillary reaction. In deep-seated ICHs, only high age correlated significantly with poor outcome. Conclusions: At long-term follow-up, most ICH survivors had a favorable clinical outcome. Neither mortality nor long-term functional outcome differed between patients operated for lobar or deep-seated ICH. A combination of surgery and neurocritical care can result in favorable clinical outcome, regardless of ICH location.
(Less)
- author
- Hessington, Amel
; Tsitsopoulos, Parmenion P.
; Fahlström, Andreas
and Marklund, Niklas
LU
- organization
- publishing date
- 2018-09-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Craniotomy, Intracerebral hemorrhage, Mortality, Outcome, Prognostic factors, Surgery
- in
- Acta Neurochirurgica
- volume
- 160
- issue
- 9
- pages
- 11 pages
- publisher
- Springer
- external identifiers
-
- pmid:30051159
- scopus:85050655916
- ISSN
- 0001-6268
- DOI
- 10.1007/s00701-018-3622-9
- language
- English
- LU publication?
- yes
- id
- 044bd0d5-edf1-483b-a843-9993f2868f74
- date added to LUP
- 2018-09-13 15:19:35
- date last changed
- 2025-04-04 15:01:49
@article{044bd0d5-edf1-483b-a843-9993f2868f74,
abstract = {{<p>Background: In spontaneous supratentorial intracerebral hemorrhage (ICH), the role of surgical treatment remains controversial, particularly in deep-seated ICHs. We hypothesized that early mortality and long-term functional outcome differ between patients with surgically treated lobar and deep-seated ICH. Method: Patients who underwent craniotomy for ICH evacuation from 2009 to 2015 were retrospectively evaluated and categorized into two subgroups: lobar and deep-seated ICH. The modified Rankin Scale (mRS) was used to evaluate long-term functional outcome. Result: Of the 123 patients operated for ICH, 49.6% (n = 61) had lobar and 50.4% (n = 62) deep-seated ICH. At long-term follow-up (mean 4.2 years), 25 patients (20.3%) were dead, while 51.0% of survivors had a favorable outcome (mRS score ≤ 3). Overall mortality was 13.0% at 30 days and 17.9% at 6 months post-ictus, not influenced by ICH location. Mortality was higher in patients ≥ 65 years old (p = 0.020). The deep-seated group had higher incidence and extent of intraventricular extension, younger age (52.6 ± 9.0 years vs. 58.5 ± 9.8 years; p < 0.05), more frequently pupillary abnormalities, and longer neurocritical care stay (p < 0.05). The proportion of patients with good outcome was 48.0% in deep-seated vs. 54.1% in lobar ICH (p = 0.552). In lobar ICH, independent predictors of long-term outcome were age, hemorrhage volume, preoperative level of consciousness, and pupillary reaction. In deep-seated ICHs, only high age correlated significantly with poor outcome. Conclusions: At long-term follow-up, most ICH survivors had a favorable clinical outcome. Neither mortality nor long-term functional outcome differed between patients operated for lobar or deep-seated ICH. A combination of surgery and neurocritical care can result in favorable clinical outcome, regardless of ICH location.</p>}},
author = {{Hessington, Amel and Tsitsopoulos, Parmenion P. and Fahlström, Andreas and Marklund, Niklas}},
issn = {{0001-6268}},
keywords = {{Craniotomy; Intracerebral hemorrhage; Mortality; Outcome; Prognostic factors; Surgery}},
language = {{eng}},
month = {{09}},
number = {{9}},
pages = {{1737--1747}},
publisher = {{Springer}},
series = {{Acta Neurochirurgica}},
title = {{Favorable clinical outcome following surgical evacuation of deep-seated and lobar supratentorial intracerebral hemorrhage : a retrospective single-center analysis of 123 cases}},
url = {{http://dx.doi.org/10.1007/s00701-018-3622-9}},
doi = {{10.1007/s00701-018-3622-9}},
volume = {{160}},
year = {{2018}},
}