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

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...

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Autores principales: Fahlström, Andreas, Tobieson, Lovisa, Redebrandt, Henrietta Nittby, Zeberg, Hugo, Bartek, Jiri, Bartley, Andreas, Erkki, Maria, Hessington, Amel, Troberg, Ebba, Mirza, Sadia, Tsitsopoulos, Parmenion P., Marklund, Niklas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Vienna 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484090/
https://www.ncbi.nlm.nih.gov/pubmed/30877470
http://dx.doi.org/10.1007/s00701-019-03853-0
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author Fahlström, Andreas
Tobieson, Lovisa
Redebrandt, Henrietta Nittby
Zeberg, Hugo
Bartek, Jiri
Bartley, Andreas
Erkki, Maria
Hessington, Amel
Troberg, Ebba
Mirza, Sadia
Tsitsopoulos, Parmenion P.
Marklund, Niklas
author_facet Fahlström, Andreas
Tobieson, Lovisa
Redebrandt, Henrietta Nittby
Zeberg, Hugo
Bartek, Jiri
Bartley, Andreas
Erkki, Maria
Hessington, Amel
Troberg, Ebba
Mirza, Sadia
Tsitsopoulos, Parmenion P.
Marklund, Niklas
author_sort Fahlström, Andreas
collection PubMed
description 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.
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spelling pubmed-64840902019-05-15 Differences in neurosurgical treatment of intracerebral haemorrhage: a nation-wide observational study of 578 consecutive patients Fahlström, Andreas Tobieson, Lovisa Redebrandt, Henrietta Nittby Zeberg, Hugo Bartek, Jiri Bartley, Andreas Erkki, Maria Hessington, Amel Troberg, Ebba Mirza, Sadia Tsitsopoulos, Parmenion P. Marklund, Niklas Acta Neurochir (Wien) Original Article - Vascular Neurosurgery - Other 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. Springer Vienna 2019-03-15 2019 /pmc/articles/PMC6484090/ /pubmed/30877470 http://dx.doi.org/10.1007/s00701-019-03853-0 Text en © The Author(s) 2019 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 - Vascular Neurosurgery - Other
Fahlström, Andreas
Tobieson, Lovisa
Redebrandt, Henrietta Nittby
Zeberg, Hugo
Bartek, Jiri
Bartley, Andreas
Erkki, Maria
Hessington, Amel
Troberg, Ebba
Mirza, Sadia
Tsitsopoulos, Parmenion P.
Marklund, Niklas
Differences in neurosurgical treatment of intracerebral haemorrhage: a nation-wide observational study of 578 consecutive patients
title Differences in neurosurgical treatment of intracerebral haemorrhage: a nation-wide observational study of 578 consecutive patients
title_full Differences in neurosurgical treatment of intracerebral haemorrhage: a nation-wide observational study of 578 consecutive patients
title_fullStr Differences in neurosurgical treatment of intracerebral haemorrhage: a nation-wide observational study of 578 consecutive patients
title_full_unstemmed Differences in neurosurgical treatment of intracerebral haemorrhage: a nation-wide observational study of 578 consecutive patients
title_short Differences in neurosurgical treatment of intracerebral haemorrhage: a nation-wide observational study of 578 consecutive patients
title_sort differences in neurosurgical treatment of intracerebral haemorrhage: a nation-wide observational study of 578 consecutive patients
topic Original Article - Vascular Neurosurgery - Other
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484090/
https://www.ncbi.nlm.nih.gov/pubmed/30877470
http://dx.doi.org/10.1007/s00701-019-03853-0
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