Spontaneous Supratentorial Intracerebral Hematoma Research Articles

Minimally Invasive Intracerebral Hematoma Evacuation Using a Novel Cost-Effective Tubular Retractor: Single-Center Experience

Spontaneous intracerebral hematoma (ICH) is a common disease with a dismal overall prognosis. Recent development of minimally invasive ICH evacuation techniques has shown promising results. Commercially available tubular retractors are commonly used for minimally invasive ICH evacuation yet are globally unavailable. A novel U.S. $7 cost-effective, off-the-shelf, atraumatic tubular retractor for minimally invasive intracranial surgery is described. Patients with acute spontaneous ICH underwent microsurgical tubular retractor-assisted minimally invasive ICH evacuation using the novel retractor. Patient outcome was retrospectively analyzed and compared with open surgery and with commercial tubular retractors. Ten adult patients with spontaneous supratentorial ICH and median preoperative Glasgow Coma Scale score of 10 were included. ICH involved the frontal lobe, parietal lobe, occipitotemporal region, and solely basal ganglia in 3, 3, 2, and 2 patients, respectively. Mean preoperative ICH volume was 80 mL. Mean residual hematoma volume was 8.7 mL and mean volumetric hematoma reduction was 91% (median, 94%). Seven patients (70%) underwent >90% volumetric hematoma reduction. The total median length of hospitalization was 26 days. On discharge, the median Glasgow Coma Scale score was 12.5 (mean, 11.7). Thirty to 90 days' follow-up data were available for 9 patients (90%). The mean follow-up modified Rankin Scale score was 3.7 and 5 patients (56%) had a modified Rankin Scale score of3. The novel cost-effective tubular retractor and microsurgical technique offer a safe and effective method for minimally invasive ICH evacuation. Cost-effective tubular retractors may continue to present a valid alternative to commercial tubular retractors.

Early versus delayed surgical evacuation of spontaneous supratentorial intracerebral hematoma: A prospective cohort study.

Background: The optimum timing for surgical evacuation of spontaneous supratentorial intracerebral hematoma (ICH) is still controversial. The aim of this study was to compare the clinical outcome following early versus delayed surgical evacuation of spontaneous supratentorial ICH.Methods: This is a prospective cohort study including 70 patients with spontaneous supratentorial ICH ≥30 cc in volume and Glasgow Coma Scale 8–12. Patients were divided into two groups based on the time interval between ictus and surgery; Group A (evacuated within 8 h from ictus) and Group B (evacuated >8 h from ictus). Outcome was assessed at discharge and at 2 months postoperative using extended Glasgow Outcome Scale.Results: The early evacuation group (Group A) included 44 patients and the late evacuation group (Group B) included 26 patients. Favorable outcome was achieved in 20.5% of the patients in Group A and in 11.5% of the patients in Group B. Mortality rate was 18.2% in Group A and 26.9% in Group B. Three patients in Group A and one patient in Group B required reoperation. The mean hospital stay was 17.18 days and 14.54 days in Groups A and B, respectively.Conclusion: Early surgical evacuation of spontaneous supratentorial ICH in patients with good preoperative conscious level is associated with better clinical outcome, particularly in the early postoperative period. Early surgical evacuation has no significant impact on the rate of reoperation or the length of hospital stay.

The Functional Outcome of Spontaneous Hypertensive Supratentorial Intracerebral Haemorrhage after Surgery

This study was to determine the different parameters that affect the outcome and the functional recovery after surgical evacuation of spontaneous hypertensive supratentorial intracerebral haemorrhage. This cross-sectional analytic study was conducted in the Department of Neuro- surgery, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh during a period of 4 years from January 2016 to December 2019 and total 96 patients were included in this study. Patients with post-traumatic hematomas, intracranial space-occupying lesions with bleeds, haemorrhagic transformation of an ischemic stroke, vascular malformations, aneurysms, and infratentorial haemorrhages were excluded from the study. Decompressive craniotomy and evacuation of clot was performed in most of the cases. The outcome of the patients was categorized according to the Glasgow Outcome Scale. Outcome was classified as “favourable” if the Glasgow Outcome Scale (GOS) score was 5 or 4, and classified as “unfavorable” if GOS score was 3 or less. The mean age of the patients was 57.99±12.74 years with male and female ratio was 1.66. The mean blood volume was 28±19.99 cc and all patients were hypertensive. There was significant difference (p <0.001) in outcome in relation of age and volume of blood. Age > 70 years, GCS < 8 on admission, clot volume above 40 cc, and intraventricular extension remain the most consistent predictors of mortality and poor outcome following surgical evacuation of spontaneous supratentorial intracerebral hematoma. The present study could only assess mortality and the functional outcome. Since a proportion of survivors had an unfavorable outcome, quality of life measures is important and need to be addressed in future studies.

Clinico-Radiological Factors Affecting Outcome of Supratentorial Spontaneous Intracerebral Hemorrhage: A Single Institute Experience

Introduction: Intracerebral bleeds are the second most common cause of stroke. The initial consciousness level and progressive deterioration and various radiological parameters like hematoma volume, its expansion, mass effect and location has been implicated with poor outcomes of Intracerebral Hematoma (ICH) regardless of the management methods. In this study we aimed to study various clinical and radiological parameters associated with outcome of spontaneous supratentorial ICH.
 Methods: This prospective study was carried out in 89 patients of spontaneous supratentorial ICH admitted to National Institute of Neurological and Allied Sciences, Nepal in between January 2015 to December 2015 to assess various parameters associated with its outcome. Outcome of the patients were assessed against various clinic-radiological and demographic variables using chi square test and student’s t test respectively for categorical and continuous variables using IBM SPSS 20 software.
 Results: Glasgow Coma Scale (GCS) (p=0.00), size of hematoma (p=0.034), presence of midline shift (0.000) and presence of intraventricular hematoma (p=0.020) were found to have statistically significant difference when compared in between good and poor outcome group.
 Conclusion: GCS at admission, size of hematoma, midline shift in cerebral tomography scan (CT scan) and presence of intraventricular hemorrhage (IVH) were significantly associated with outcome of spontaneous Supratentorial ICH.

Technical Notes and Result of Stereotactic Evacuation of Hematoma in Spontaneous Supratentorial Intracerebral Hematoma

Primary intracerebral hematoma constitutes about 10-15% of all strokes and is associated with high mortality and severe disability. Surgical treatment of intracerebral hemorrhage is quite controversial. It is believed that minimal invasive stereotactic surgery may reduce hematoma volume and decrease secondary neurotoxicity. The technical note of stereotactic surgery has been illustrated. A retrospective study from March 2016 to March 2018 has been conducted and all patients who underwent stereotactic evacuation of hematoma were included in this study. Baseline characteristics of patients and outcome in terms of Glasgow Coma Scale (GCS) and Modified Rankin Scale (mRS) have been shown. We have found significant improvement in GCS postoperatively, however mRS did not improve immediately but was significantly better in three months follow up period.

Endoscopic surgery of spontaneous supratentorial intracerebral hematoma assisted by virtual reality and augmented reality

Objective To study the feasibility and clinical effectiveness of endoscopic removal of spontaneous supratentorial hematoma assisted by virtual reality (VR) and augmented reality (AR). Methods A retrospective analysis was conducted with 36 patients with spontaneous supratentorial hematoma who were admitted to the neurosurgery department of PLA General Hospital from September 2014 to October 2015. Based on the hospital picture archiving and communication (PACS) system, three-dimensional visualization of the patients’ hematomas and head outlines were achieved assisted by VR. The technology of AR, used together with imaging fusion application (APP) on android-system cell phones, helped physicians design trajectory to of hematomas. A perforator and transparent sheath were used to set up a working channel for removal of hematomas with endoscopes. Post-operative CT was conducted one day after surgery and volumes of hematomas were calculated with the software of 3D-slicer. The parameters were documented including hematoma evacuation rate, operation time, intraoperative blood loss, preoperative and postoperative (1 week post surgery) scores based on the Glasgow Coma Scale (GCS). Results Successful punctures to reach hematomas were achieved with the assistance of VR and AR in call cases. The mean operation time and actual endoscopic operation time were 54.0±9.6 min and 33.0±7.2 min, respectively. The mean amount of blood loss during operation was 80.0±21.5 ml. None of the cases developed postoperative re-bleeding. The average evacuation rate was 95.4%. The mean preoperative GCS score was 6.7±1.6, which was significantly increased to 12.6±1.9 (P<0.01) graded 1 week post surgery. Conclusions The technologies of VR based on hospital PACS systems and AR based on cell phone APP could help precisely localize the intracerebral hematomas and select appropriate puncture trajectory. With a working channel established by transparent sheath, the endoscope could help achieve satisfactory removal of hematomas and improve the outcome. Key words: Cerebral hemorrhage; Neuroendoscopy; Visual reality; Treatment outcome

Evacuation of spontaneous supratentorial intracerebral hematoma with double targets-single channel and multiaxial stereotaxis

To evaluate the efficacy and safety of evacuation of spontaneous supratentorial hemorrhage with double targets-single channel and multiaxial stereotaxis. Thirty-four patients with supratentorial intracerebral hemorrhage, who underwent hematoma evacuation with the method of double targets-single channel between January 2014 and November 2014 in the Second Affiliated Hospital, Zhejiang University School of Medicine, were included in the study. We classified the hematoma into four types based on the principle of double targets-single channel calculation method (DTSC). And the appropriate stereotactic surgery path and operation opportunity were designed individually according to the hematoma volume and mass effect. Twenty-seven patients with supratentorial hemorrhage who underwent hematoma evacuation with the method of single targets-single channel between January 2013 and November 2014 were selected as single target group. Volumes of initial hematoma in DTSC and single target groups were(38.6 ± 19.2)mL and(40.1 ± 18.1)mL, respectively. Initial Glasgow Coma Scale were 9.6 ± 3.2 (3~15) and 9.1 ± 2.9(3~13) (all P >0.05). Residual volume of hematoma and clearance ratio were (11.1 ± 4.2) mL and(73.1 ± 5.4)% in DTSC group and (18.5 ± 5.3) mL and(55.1 ± 5.1)% in single target group by CT scan 24 h after operation(all P <0.05). There was no significant difference in Glasgow Outcome Scale between two groups in one-month follow-up. Average length of postoperative stay of two groups were(12.6 ± 9.8)d and (14.2 ± 7.1)d, respectively. Evacuation of spontaneous supratentorial intracerebral hematoma with DTSC and multi-axial stereotaxis can increase clearance ratio remarkably and decrease average length of stay.

Timing Is Everything in Intracerebral Hemorrhage

To the Editor: Hallevi and coworkers recently reported on the off-label use of rFVIIa in 46 patients with ICH.1 Twenty-four patients received rFVIIa within 3 hours, and 22 within 3 to 4 hours. Volume increase and outcome at discharge were compared with 148 historical controls. The authors did not find a difference in reduction of volume increase between the 0 to 3 and the 3 to 4 hour group. Nor did they find a difference in outcome between the factor VIIa treated and the control patients. They conclude that timing of hemostatic therapy may not have an influence on volume reduction or outcome in ICH patients. We are not as quick to agree with this conclusion, for the following reasons: First, mean volumes were remarkably smaller—only one-third—than volumes that were found in FAST.2 Size of …

Is Craniotomy for Intracerebral Hemorrhage Treated Properly in the Latest AHA Guideline?

HomeStrokeVol. 39, No. 4Is Craniotomy for Intracerebral Hemorrhage Treated Properly in the Latest AHA Guideline? Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBIs Craniotomy for Intracerebral Hemorrhage Treated Properly in the Latest AHA Guideline? Eiharu Morikawa Eiharu MorikawaEiharu Morikawa Section of Cerebrovascular Surgery, Stroke Center, Saitama Medical University International Medical Center, Hidakashi, Saitama, Japan Search for more papers by this author Originally published28 Feb 2008https://doi.org/10.1161/STROKEAHA.107.503623Stroke. 2008;39:e69Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: February 28, 2008: Previous Version 1 To the Editor:Beneficial effects of the surgical intervention, especially craniotomy, for the treatment of patients with putaminal hemorrhage, is inconclusive. In the recent issue of Stroke,1 guidelines for the treatment of spontaneous intracerebral hemorrhage were presented. Craniotomy for the supratentorial intracerebral hemorrhage was placed Class III, not beneficial, except for the superficial lobar hemorrhage.Such a recommendation must be drawn from the results of the international STICH study,2 in which early surgical intervention yielded only marginal insignificant benefit in mortality and morbidity over initial conservative treatment. It should be noted, however, that one fourth of the initial conservative treatment group eventually had surgery within 99 hours of ictus. Initial conservative treatment policy therefore maintained just the equal levels of outcome as early surgical intervention policy, only when surgical intervention with an average time lag of 30 hours was added in a significant number of the cases.From this point of view, placement of craniotomy for the intracerebral hemorrhage in Class III category is misguiding for the physicians treating stroke patients and also for the families of the stroke patients.DisclosuresNone.1 Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D, Mayberg M, Morgenstern L, Ogilvy C, Vespa P, Zuccarello M. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage in Adults. 2007 Update. Guideline From the Am Heart Association/Am Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke. 2007; 38: 2001–2023.LinkGoogle Scholar2 Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, Karimi A, Shaw MD, Barer DH. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. The Lancet. 2005; 365: 387–397.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails April 2008Vol 39, Issue 4 Advertisement Article InformationMetrics https://doi.org/10.1161/STROKEAHA.107.503623PMID: 18309147 Originally publishedFebruary 28, 2008 PDF download Advertisement

Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomized trial

Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomized trial

Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial

Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial

Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial

Spontaneous supratentorial intracerebral haemorrhage accounts for 20% of all stroke-related sudden neurological deficits, has the highest morbidity and mortality of all stroke, and the role of surgery remains controversial. We undertook a prospective randomised trial to compare early surgery with initial conservative treatment for patients with intracerebral haemorrhage. A parallel-group trial design was used. Early surgery combined haematoma evacuation (within 24 h of randomisation) with medical treatment. Initial conservative treatment used medical treatment, although later evacuation was allowed if necessary. We used the eight-point Glasgow outcome scale obtained by postal questionnaires sent directly to patients at 6 months follow-up as the primary outcome measure. We divided the patients into good and poor prognosis groups on the basis of their clinical status at randomisation. For the good prognosis group, a favourable outcome was defined as good recovery or moderate disability on the Glasgow outcome scale. For the poor prognosis group, a favourable outcome also included the upper level of severe disability. Analysis was by intention to treat. 1033 patients from 83 centres in 27 countries were randomised to early surgery (503) or initial conservative treatment (530). At 6 months, 51 patients were lost to follow-up, and 17 were alive with unknown status. Of 468 patients randomised to early surgery, 122 (26%) had a favourable outcome compared with 118 (24%) of 496 randomised to initial conservative treatment (odds ratio 0.89 [95% CI 0.66-1.19], p=0.414); absolute benefit 2.3% (-3.2 to 7.7), relative benefit 10% (-13 to 33). Patients with spontaneous supratentorial intracerebral haemorrhage in neurosurgical units show no overall benefit from early surgery when compared with initial conservative treatment.

Prognostic factors in a series of 185 consecutive spontaneous supratentorial intracerebral haematomas

We report a retrospective observational study of 185 cases with spontaneous supratentorial intracerebral haemorrhage, in which, by univariate and multivariate analysis, the main clinical and CT findings influencing patient outcome were studied. Forty (22%) patients died and 77 (41%) remained in a very disabled state. Using logistic regression analysis we found that the volume of the haematoma, its deep location, surgical treatment and the preictal status in relation to activities of daily living (ADL) were independent factors for patient outcome measured with the Modified Rankin Scale. Similarly, GCS at presentation, preictal status in relation to ADL and age were directly correlated with mortality at 6 months follow-up. We also observed that age, GCS at admission and the volume of the haematoma, were the main factors influencing the neurosurgeon's decision regarding surgical treatment.

The treatment of spontaneous intracerebral hemorrhage

In a prospective study, 52 patients with a spontaneous supratentorial intracerebral hematoma (ICH) were randomly assigned to receive emergency surgery or conservative treatment within 48 hours after the bleed. Patients with a decreased level of consciousness and/or a severe neurological deficit were admitted to the study. The overall mortality rate at 6 months was 42%: 10 (38%) of the 26 patients in the conservative group and 12 (46%) of the 26 in the surgical group. Six (20%) of the 30 survivors at 6 months were able to conduct their activities of daily living independently: five (31%) of the 16 patients in the conservative group and one (7%) of the 14 in the operative group. These differences are not statistically significant. The mortality rate of semicomatose or stuporous patients (Glasgow Coma Scale score 7 to 10) was statistically significantly lower in the surgical group (none of the four patients) than in the conservative group (four of five patients) (p less than 0.05); however, all surviving patients in this subgroup were severely disabled. The study suggests that surgical treatment of this category of patients with ICH does not offer any definite advantage over conservative treatment. In semicomatose or stuporous patients, surgery may improve the length of survival, but the quality of life remains poor.