Surgical and conservative treatment of patients with non-traumatic intracerebral hematoma: pros and cons

Abstract

The risk and benefits of early neurosurgical intervention in patients with non-traumatic intracerebral hematoma (NICH) are still unclear. To evaluate an effectiveness of early surgery in patients with NICH compared to primary conservative therapy. There were 115 patients with indications for surgery. The indications were supratentorial NICH over 30 cm3 and GCS score >7 points. All patients were divided into 2 groups: the main group (n=59) - NICH removal within 24 hours; the control group (n=56) - conservative treatment only. Both groups were comparable by the main clinical, demographic and neuroimaging characteristics. We analyzed survival rates and functional status using Glasgow outcome scale extended (GOSE) 6 months later. Median survival in the main group was 71 days vs. 11 days in the control group (p<0.05); cumulative 6-month survival - 46% and 34%, respectively (p>0.05). Surgical treatment resulted higher number of patients with severe (13% vs. 5%) and moderate disability (29% vs. 23%). There were 2% of patients with good recovery in the group of surgical treatment and 4% of patients after conservative management. However, between-group differences were not significant (p>0.05). Early surgical evacuation of non-traumatic intracerebral hematoma is accompanied by less early postoperative mortality. There were no significant between-group differences in functional outcomes and survival rates after 6 months.