Surgery for Supratentorial Spontaneous Intracerebral Haemorrhage: A Retrospective Analysis from a Hospital-based Stroke Register

Abstract

Introduction: Intracerebral haemorrhage (ICH) constitutes about 5% to 20% of all strokes. Surgery for ICH has always been controversial with conflicting opinions. While multiple trials have doubted the positive effect of surgery in supratentorial ICH, it is now increasingly practiced across the world. The present study attempts to study outcome predictors following surgical evacuation for supratentorial ICH. Methodology: This is a retrospective analysis from a prospective ICH register on all patients who underwent surgical evacuation for supratentorial ICH between January 2015 and December 2017. Preoperative variables and postoperative complications were analyzed. The outcome was measured by the Modified Rankin Scale (mRS) at discharge and 3 months. Results: Our study group of 94 patients included 78 capsuloganglionic, 13 lobar, and 3 thalamic hematomas. The mean age of the study cohort was 52.72 ± 12.2 years with an overall male preponderance. Major comorbidities included hypertension in 55 (58.5%) and diabetes mellitus in 17 (18.1%). The median preoperative Glasgow Coma Scale (GCS) was 9 and the mean hematoma volume was 49.32 ± 19.01 ml. Standard craniotomy and clot evacuation were done in 61 patients, whereas 33 patients underwent decompressive craniectomy with hematoma evacuation and expansile duroplasty. Majority of the patients (60/94) underwent surgical evacuation within 6 to 24 hours. Residual bleed was seen in 25 patients (34.4%) and rebleed occurred in 9 patients. Major complications included ventilator-assisted pneumonia (35.1%), meningitis (18.1%), and septicaemia (12.8%). Our overall surgical mortality was 31/94 (32.9%) and the median GCS at discharge was 11.5. Median mRS was 5 and 4 at discharge and 90 days, respectively. Age, GCS < 8, and rebleed were independent predictors of mortality in surgically operated patients ( P < .05). Nondominant hemispheric clots and lobar hematoma carry better long-term outcomes ( P < .05). The type, timing of surgery, and sex did not have a significant influence on the outcome. Conclusion: Surgical evacuation of spontaneous intracerebral hemorrhage helps in significantly reducing mortality for younger patients with a preoperative GCS > 8 and clot volumes between 20 and 40 ml. Lobar hematoma carries better long-term outcomes and rebleeding affects outcomes adversely. More studies in future are required to redefine surgical indications.