Comparison of efficacy of surgery and conservative treatment for patients with critical spontaneous deep supratentorial intracerebral hemorrhage

Abstract

Objective To study and compare the efficacy of surgery and conservative treatments for patients with critical (30 to 50 ml) spontaneous deep supratentorial intracerebral hemorrhage. Methods The clinical data of 420 patients diagnosed as spontaneous deep supratentorial intracerebral hemorrhage in Affiliated Hospital of Yan′an and Central Hospital of Baoji from August 2011 to September 2016 in this study were retrospectively analyzed. All patients were divided into surgery group (210 cases) and conservative group (210 cases) according to the difference of treatment methods. Large trauma craniotomy was used by the operation group, external ventricular drainage as the standby in necessary. The treatment of conservative group mainly included reduction of intracranial pressure, blood pressure management, prevention of complications and other individualized treatment. The primary outcome was neurological functional status of patients at 6 months of discharging, and the secondary outcomes included the mortality at 1 month and 6 months of discharging, and complications. Continuous data were presented as ±s and were compared using the t test, while categorical data were presented as number and percentage and were compared using the χ2 test. Results No obvious difference on mRS score and NIHSS score occurred between two groups (All P>0.05). Stratified analysis, patients with midline shift >5 mm and with intraventricular hemorrhage were more likely to have a favorable outcome from surgery compared with conservative group (18.2% vs. 8.1%, χ2=4.099, P=0.043; 17.3% vs. 5.0%, χ2=4.836, P=0.028). The mortality at 1 month days and 6 months in surgery group were significantly lower than that in conservative group (19.0% vs. 31.0%, χ2=7.937, P=0.005; 23.8% vs. 36.7%, χ2=8.228, P=0.004). Meanwhile, the incidence of pulmonary infection and with long-term pipe in surgery group were significantly higher than those in conservative group (31.9% vs. 15.7%, χ2=15.173, P=0.000; 28.6% vs. 19.5%, χ2=4.706, P=0.030). Conclusion Surgery can reduce the 1 month and 6 months mortality in patients with spontaneous deep supratentorial hemorrhage and improve the functional outcomes in patients with large midline shift or with intraventricular hemorrhage compared with conservative treatment. Key words: Cerebral hemorrhage; Surgical procedures, operative; Spontaneous deep supratentorial intracerebral hemorrhage; Treatment outcome; Conservative treatment