Comparing the results of surgical and conservative treatment of patients with supratentorial hypertensive intracerebral hemorrhage. A new look at previously known randomized studies

Abstract

Hemorrhagic stroke is a medical and social problem, with an incidence of 15–35 per 100 000 people per year. It is characterized by high patient mortality (up to 53% in the first year) and disability, with most of the surviving patients having persistent neurological deficits and about 20% of them requiring continuous assistance. The advantages of surgical or conservative treatment of patients with supratentorial hypertensive intracerebral hemorrhage (ICH) are still under discussion. This literature review is based on 12 open-source articles on prospective randomized trials comparing conservative and surgical treatment results in patients with supratentorial ICH, which demonstrate contradictory results. Based on an analysis of all the works, we can conclude that surgical treatment has an advantage when performed early (within 12–72 hours) in patients whose level of consciousness is 9–12 points on the Glasgow Coma Scale. Needle aspiration and local fibrinolysis are effective for basal ganglia ICH, while open surgery and endoscopic aspiration are effective in subcortical ICH. For subcortical ICHs that are 20–80 cm 3 in size, surgical treatment improved functional outcomes, while in ICHs larger than 50 cm 3 , it helped to reduce mortality. For citation: Godkov I.M., Dashyan V.G. [Comparing the results of surgical and conservative treatment of patients with supratentorial hypertensive intracerebral hemorrhage. A new look at previously known randomized studies]. Annals of clinical and experimental neurology. 2021; 15(1): 71–79. (In Russ.) https://doi.org/10.25692/ACEN.2021.1.9