Abstract
Objective: Despite no clear evidence from randomized trials, surgical intervention of spontaneous intracerebral hemorrhage (ICH) still occurs. We sought to describe the characteristics of patients undergoing surgical intervention in ICH. Methods: Data from the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study were analyzed, and ICH patients were categorized into surgical intervention or nonoperative management groups. Patients with primary intraventricular hemorrhage (IVH) and those without data regarding the use of surgical intervention data were excluded. Multivariable models were developed to identify predictors of surgical intervention. Results: The study cohort comprised 2,947 patients, and surgical intervention was performed in 289 (10%). Younger age (p<0.001), lower baseline modified Rankin Scale score (mRS; p<0.001), higher admission Glasgow Coma Scale (GCS; p=0.007), larger ICH volume (p<0.001), infratentorial ICH location (p<0.001), lobar ICH location (p<0.001), lack of IVH (p=0.001), ICP monitoring (p<0.001), and mannitol use (p<0.001) were independent predictors of surgical intervention. Younger age (p<0.001), lower baseline mRS score (p=0.002), larger ICH volume (p<0.001), lobar ICH location (p<0.001), ICP monitoring (p<0.001), and mannitol use (p<0.001) were independent predictors of surgical interventions in supratentorial ICHs. Larger ICH volume (p<0.001), ICP monitoring (p<0.001), and mannitol use (p=0.005) were independent predictors of surgical interventions in infratentorial ICHs. Conclusion: We identified multiple factors associated with surgical intervention for patients with ICH. Younger age, good neurological function at baseline, large ICH volume on presentation, and lobar or infratentorial hematomas were independently associated with surgical intervention in ICH patients. Additional studies are necessary to determine the risk to benefit profile of ICH surgery.
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