Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Differences in neurosurgical treatment of intracerebral haemorrhage : a nation-wide observational study of 578 consecutive patients

Fahlström, Andreas ; Tobieson, Lovisa ; Redebrandt, Henrietta Nittby LU ; Zeberg, Hugo ; Bartek, Jiri ; Bartley, Andreas ; Erkki, Maria ; Hessington, Amel ; Troberg, Ebba LU and Mirza, Sadia , et al. (2019) In Acta Neurochirurgica 161(5). p.955-965
Abstract

Background: Supratentorial intracerebral haemorrhage (ICH) carries an excessive mortality and morbidity. Although surgical ICH treatment can be life-saving, the indications for surgery in larger cohorts of ICH patients are controversial and not well defined. We hypothesised that surgical indications vary substantially among neurosurgical centres in Sweden. Objective: In this nation-wide retrospective observational study, differences in treatment strategies among all neurosurgical departments in Sweden were evaluated. Methods: Patient records, neuroimaging and clinical outcome focused on 30-day mortality were collected on each operated ICH patient treated at any of the six neurosurgical centres in Sweden from 1 January 2011 to 31... (More)

Background: Supratentorial intracerebral haemorrhage (ICH) carries an excessive mortality and morbidity. Although surgical ICH treatment can be life-saving, the indications for surgery in larger cohorts of ICH patients are controversial and not well defined. We hypothesised that surgical indications vary substantially among neurosurgical centres in Sweden. Objective: In this nation-wide retrospective observational study, differences in treatment strategies among all neurosurgical departments in Sweden were evaluated. Methods: Patient records, neuroimaging and clinical outcome focused on 30-day mortality were collected on each operated ICH patient treated at any of the six neurosurgical centres in Sweden from 1 January 2011 to 31 December 2015. Results: In total, 578 consecutive surgically treated ICH patients were evaluated. There was a similar incidence of surgical treatment among different neurosurgical catchment areas. Patient selection for surgery was similar among the centres in terms of patient age, pre-operative level of consciousness and co-morbidities, but differed in ICH volume, proportion of deep-seated vs. lobar ICH and pre-operative signs of herniation (p <.05). Post-operative patient management strategies, including the use of ICP-monitoring, CSF-drainage and mechanical ventilation, varied among centres (p <.05). The 30-day mortality ranged between 10 and 28%. Conclusions: Although indications for surgical treatment of ICH in the six Swedish neurosurgical centres were homogenous with regard to age and pre-operative level of consciousness, important differences in ICH volume, proportion of deep-seated haemorrhages and pre-operative signs of herniation were observed, and there was a substantial variability in post-operative management. The present results reflect the need for refined evidence-based guidelines for surgical management of ICH.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and , et al. (More)
; ; ; ; ; ; ; ; ; ; and (Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Craniotomy, External ventricular drain, Guidelines, Intracerebral haemorrhage, Intraventricular haemorrhage, Surgery
in
Acta Neurochirurgica
volume
161
issue
5
pages
955 - 965
publisher
Springer
external identifiers
  • scopus:85063056347
  • pmid:30877470
ISSN
0001-6268
DOI
10.1007/s00701-019-03853-0
language
English
LU publication?
yes
id
284fb49d-fddb-442f-a51d-b92458bb7a61
date added to LUP
2019-03-29 14:28:45
date last changed
2024-04-30 03:29:22
@article{284fb49d-fddb-442f-a51d-b92458bb7a61,
  abstract     = {{<p>Background: Supratentorial intracerebral haemorrhage (ICH) carries an excessive mortality and morbidity. Although surgical ICH treatment can be life-saving, the indications for surgery in larger cohorts of ICH patients are controversial and not well defined. We hypothesised that surgical indications vary substantially among neurosurgical centres in Sweden. Objective: In this nation-wide retrospective observational study, differences in treatment strategies among all neurosurgical departments in Sweden were evaluated. Methods: Patient records, neuroimaging and clinical outcome focused on 30-day mortality were collected on each operated ICH patient treated at any of the six neurosurgical centres in Sweden from 1 January 2011 to 31 December 2015. Results: In total, 578 consecutive surgically treated ICH patients were evaluated. There was a similar incidence of surgical treatment among different neurosurgical catchment areas. Patient selection for surgery was similar among the centres in terms of patient age, pre-operative level of consciousness and co-morbidities, but differed in ICH volume, proportion of deep-seated vs. lobar ICH and pre-operative signs of herniation (p &lt;.05). Post-operative patient management strategies, including the use of ICP-monitoring, CSF-drainage and mechanical ventilation, varied among centres (p &lt;.05). The 30-day mortality ranged between 10 and 28%. Conclusions: Although indications for surgical treatment of ICH in the six Swedish neurosurgical centres were homogenous with regard to age and pre-operative level of consciousness, important differences in ICH volume, proportion of deep-seated haemorrhages and pre-operative signs of herniation were observed, and there was a substantial variability in post-operative management. The present results reflect the need for refined evidence-based guidelines for surgical management of ICH.</p>}},
  author       = {{Fahlström, Andreas and Tobieson, Lovisa and Redebrandt, Henrietta Nittby and Zeberg, Hugo and Bartek, Jiri and Bartley, Andreas and Erkki, Maria and Hessington, Amel and Troberg, Ebba and Mirza, Sadia and Tsitsopoulos, Parmenion P. and Marklund, Niklas}},
  issn         = {{0001-6268}},
  keywords     = {{Craniotomy; External ventricular drain; Guidelines; Intracerebral haemorrhage; Intraventricular haemorrhage; Surgery}},
  language     = {{eng}},
  month        = {{03}},
  number       = {{5}},
  pages        = {{955--965}},
  publisher    = {{Springer}},
  series       = {{Acta Neurochirurgica}},
  title        = {{Differences in neurosurgical treatment of intracerebral haemorrhage : a nation-wide observational study of 578 consecutive patients}},
  url          = {{http://dx.doi.org/10.1007/s00701-019-03853-0}},
  doi          = {{10.1007/s00701-019-03853-0}},
  volume       = {{161}},
  year         = {{2019}},
}