Summary
Surgical intervention in supratentorial intracerebral haemorrhage (ICH) is still controversial. We assessed the value of haematoma evacuation with a case-control study. 145 consecutive patients with supratentorial spontaneous ICH without tumour or vascular abnormalities were analysed. Haematoma evacuation was performed in 24 patients. Age, sex, Glasgow Coma Scale (GCS), level of consciousness, pupillary reaction on admission, localisation, aetiology and volume of the haematoma, presence of ventricular blood, and Glasgow Outcome Scale (GOS) on discharge were analysed. From statistical analysis 40 patients >80 years and with haematoma volume <10ml, who were always treated conservatively, were excluded. Prognostic factors retained from a multiple regression model with the dichotomised GOS scale (GOS 1–3, 4+5) as response variable were GCS, haematoma volume and location. The only difference between all medically treated and “operated” patients was haematoma volume, which was larger in the “operated” patients. All 24 evacuated cases could be matched to a medically treated control regarding age, haematoma volume and location, GCS, and pupillary reaction. Significant differences between the two groups could not be detected. Outcome was not different between the two groups. After separating the sample into patients with and without ventricular haemorrhage, there was no different outcome between the two groups either. We conclude that haematoma evacuation did not improve outcome in supratentorial spontaneous ICH. Since haematomas were evacuated mainly in clinically deteriorating patients, our data suggest that the only effect of haematoma evacuation is to stop progressive deterioration rather than to improve overall clinical outcome.
Similar content being viewed by others
References
Andrews B, Chiles BW, Olsen WL, Pitts LH (1988) The effect of intracranial hematoma location on the risk of brain-stem compression and on clinical outcome. J Neurosurg 69: 518–522
Auer LM, Deinsberger W, Niederkorn K,et al (1989) Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma. A randomized study. J Neurosurg 70: 530–535
Batjer HH, Reisch JS, Allen BC, Plaizier LJ, Su CJ (1990) Failure of surgery to improve outcome in hypertensive putaminal hemorrhage. Arch Neurol 47: 1103–1106
Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G (1993) Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day-mortality. Stroke 24: 987–993
Broderick JP, Brott TG, Tomsick T, Barsan W, Spilker J (1990) Ultra-early evaluation of intracerebral hemorrhage. J Neurosurg 72: 195–199
Counsell C, Boonyakarnakul S, Dennis M,et al (1995) Primary intracerebral haemorrhage in the Oxfordshire community stroke project. 2. Prognosis. Cerebrovasc Dis 5: 26–34
Dandapani BK, Suzuki S, Kelley RE, Reyes-Iglesias Y (1995) Relation between blood pressure and outcome in intracerebral hemorrhage. Stroke 26: 21–24
Daverat P, Castel JP, Dartigues JF, Orgogonzo JM (1991) Death and functional outcome after spontaneous intracerebral hemorrhage, a prospective study of 166 cases using multivariate analysis. Stroke 22: 1–6
Douglas MA, Haerer F (1982) Long-term prognosis of hypertensive intracerebral hemorrhage. Stroke 13: 488–491
Findlay JM, Grace MGA, Weir BKA (1993) Treatment of intraventricular hemorrhage with tissue plasminogen activator. Neurosurgery 32: 941–947
Fujii Y, Tanaka R, Takeuchi S,et al (1994) Hematoma enlargement in spontaneous intracerebral hemorrhage. J Neurosurg 80: 51–57
Fujitsu K, Muramoto M, Ikeda Y,et al (1990) Indications for surgical treatment of putaminal hemorrhage. J Neurosurg 73: 518–525
Gårde A, Böhmer G, Seidén B, Neimann J (1983) 100 cases of spontaneous intracerebral haematoma. Diagnosis, treatment and prognosis. Eur Neurol 22: 161–172
Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. A practical scale. Lancet i: 480–484
Jørgensen HS, Nakayama H, Raaschou HO, Olsen TS (1995) Intracerebral hemorrhage versus infarction: Stroke severity, risk factors, and prognosis. Ann Neurol 38: 45–50
Juvela S, Heiskanen O, Poranen A,et al (1989) The treatment of spontaneous intracerebral hemorrhage. A prospective randomized trial of surgical and conservative treatment. J Neurosurg 70:755–758
Kanaya H, Yukawa H, Itoh Z,et al (1980) Grading and the indications for treatment in ICH of the basal ganglia (Cooperative study in Japan). In: Pia HW, Langmaid C, Zierski J (eds) Spontaneous intracerebral haematomas. Springer, Berlin Heidelberg New York, pp 268–274
Kaneko M, Tanaka K, Shimada T, Sato K, Uemura K (1983) Long-term evaluation of ultra-early operation for hypertensive intracerebral hemorrhage in 100 cases. J Neurosurg 58: 838–842
Kanno T, Sano H, Shinomiya Y,et al (1984) Role of surgery in hypertensive intracerebral hematoma. A comparative study of 305 nonsurgical and 154 surgical cases. J Neurosurg 61: 1091–1099
Kase CS, Crowell RM (1994) Prognosis and treatment of patients with intracerebral hemorrhage. In: Kase CS, Caplan LR (eds) Intracerebral hemorrhage. Butterworth-Heinemann, Boston, pp 467–489
Lee KR, Colon GP, Betz AL,et al (1996) Edema from intracerebral hemorrhage: The role of thrombin. J Neurosurg 84: 91–96
Lisk DR, Pasteur W, Rhoades H, Putnam RD, Grotta JC (1994) Early presentation of hemispheric intracerebral hemorrhage: Prediction of outcome and guidelines for treatment allocation. Neurology 44: 133–139
McKissock W, Richardson A, Taylor J (1961) Primary intracerebral haemorrhage. A controlled trial of surgical and conservative treatment in 180 unselected cases. Lancet 2: 221–226
Mendelow AD, Bullock R, Nath FP,et al (1986) Experimental intracerebral mass: Time-related effects on local cerebral blood flow. In: Miller JD, Teasdale GM, Rowan JO,et al (eds) Intracranial pressure VI. Springer, Berlin Heidelberg New York Tokyo, pp 515–520
Misra UK, Kalita J, Srivastava M, Mandal SK (1996) A study of prognostic predictors of supratentorial haematomas. J Neurol 243: 96–100
Portenoy RK, Lipton RB, Berger AR, Lesser ML, Lantos G (1987) Intracerebral haemorrhage: A model for the prediction of outcome. J Neurol Neurosurg Psychiatry 50: 976–979
Ropper AH, Davis KR (1980) Lobar cerebral hemorrhages: Acute clinical syndromes in 26 cases. Ann Neurol 8: 141–147
Steiner I, Gomori JM, Melamed E (1984) The prognostic value of the CT scan in conservatively treated patients with intracerebral hematoma. Stroke 15: 279–282
Suzuki J, Ebina T (1980) Sequential changes in tissue surrounding ICH. In: Pia HW, Langmaid C, Zierski J (eds) Spontaneous intracerebral haematomas. Springer. Berlin Heidelberg New York, pp 121–128
Teasdale G, Jenett B (1974) Assessment of coma and impaired consciousness: A practical scale. Lancet 2: 81–83
Tuhrim S, Dambrosia JM, Price TR,et al (1988) Prediction of intracerebral hemorrhage survival. Ann Neurol 24: 258–263
Tuhrim S, Horowitz DR, Sacher M, Goldbold JH (1995) Validation and comparison of models predicting survival following intracerebral hemorrhage. Crit Care Med 23: 950–954
Volpin L, Cervellini P, Colombo F, Zanusso M, Benedetti A (1984) Spontaneous intracerebral hematomas: A new proposal about the usefulness and limits of surgical treatment. Neurosurgery 15: 663–666
Waga S, Yamamoto Y (1983) Hypertensive putaminal hemorrhage: Treatment and results. Is surgical treatment superior to conservative one? Stroke 14: 480–485
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Schwarz, S., Jauss, M., Krieger, D. et al. Haematoma evacuation does not improve outcome in spontaneous supratentorial intracerebral haemorrhage: A case-control study. Acta neurochir 139, 897–904 (1997). https://doi.org/10.1007/BF01411297
Issue Date:
DOI: https://doi.org/10.1007/BF01411297