Cargando…

Favorable clinical outcome following surgical evacuation of deep-seated and lobar supratentorial intracerebral hemorrhage: a retrospective single-center analysis of 123 cases

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-seate...

Descripción completa

Detalles Bibliográficos
Autores principales: Hessington, Amel, Tsitsopoulos, Parmenion P., Fahlström, Andreas, Marklund, Niklas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Vienna 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6105225/
https://www.ncbi.nlm.nih.gov/pubmed/30051159
http://dx.doi.org/10.1007/s00701-018-3622-9
_version_ 1783349624483872768
author Hessington, Amel
Tsitsopoulos, Parmenion P.
Fahlström, Andreas
Marklund, Niklas
author_facet Hessington, Amel
Tsitsopoulos, Parmenion P.
Fahlström, Andreas
Marklund, Niklas
author_sort Hessington, Amel
collection PubMed
description 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.
format Online
Article
Text
id pubmed-6105225
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Springer Vienna
record_format MEDLINE/PubMed
spelling pubmed-61052252018-08-30 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 Marklund, Niklas Acta Neurochir (Wien) Original Article - Neurosurgical intensive care 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. Springer Vienna 2018-07-26 2018 /pmc/articles/PMC6105225/ /pubmed/30051159 http://dx.doi.org/10.1007/s00701-018-3622-9 Text en © The Author(s) 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article - Neurosurgical intensive care
Hessington, Amel
Tsitsopoulos, Parmenion P.
Fahlström, Andreas
Marklund, Niklas
Favorable clinical outcome following surgical evacuation of deep-seated and lobar supratentorial intracerebral hemorrhage: a retrospective single-center analysis of 123 cases
title Favorable clinical outcome following surgical evacuation of deep-seated and lobar supratentorial intracerebral hemorrhage: a retrospective single-center analysis of 123 cases
title_full Favorable clinical outcome following surgical evacuation of deep-seated and lobar supratentorial intracerebral hemorrhage: a retrospective single-center analysis of 123 cases
title_fullStr Favorable clinical outcome following surgical evacuation of deep-seated and lobar supratentorial intracerebral hemorrhage: a retrospective single-center analysis of 123 cases
title_full_unstemmed Favorable clinical outcome following surgical evacuation of deep-seated and lobar supratentorial intracerebral hemorrhage: a retrospective single-center analysis of 123 cases
title_short Favorable clinical outcome following surgical evacuation of deep-seated and lobar supratentorial intracerebral hemorrhage: a retrospective single-center analysis of 123 cases
title_sort favorable clinical outcome following surgical evacuation of deep-seated and lobar supratentorial intracerebral hemorrhage: a retrospective single-center analysis of 123 cases
topic Original Article - Neurosurgical intensive care
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6105225/
https://www.ncbi.nlm.nih.gov/pubmed/30051159
http://dx.doi.org/10.1007/s00701-018-3622-9
work_keys_str_mv AT hessingtonamel favorableclinicaloutcomefollowingsurgicalevacuationofdeepseatedandlobarsupratentorialintracerebralhemorrhagearetrospectivesinglecenteranalysisof123cases
AT tsitsopoulosparmenionp favorableclinicaloutcomefollowingsurgicalevacuationofdeepseatedandlobarsupratentorialintracerebralhemorrhagearetrospectivesinglecenteranalysisof123cases
AT fahlstromandreas favorableclinicaloutcomefollowingsurgicalevacuationofdeepseatedandlobarsupratentorialintracerebralhemorrhagearetrospectivesinglecenteranalysisof123cases
AT marklundniklas favorableclinicaloutcomefollowingsurgicalevacuationofdeepseatedandlobarsupratentorialintracerebralhemorrhagearetrospectivesinglecenteranalysisof123cases