SURGICAL VERSUS CONSERVATIVE TREATMENT OF SPONTANEOUS INTRACEREBRAL HEMORRHAGE

Abstract

Background: Spontaneous intracerebral hemorrhage (sICH) causes severe disability and high mortality. Today it is still an unresolved medical problem. The choice of optimal management - surgical or conservative, remains a difficult and controversial one. Early evacuation may restrict hematoma expansion and limit the secondary brain damage, improving the outcome for the patient. Objective(s): To compare the effectiveness of surgical to conservative treatment of sICH. Material(s) and Method(s): We examined 94 patients with sICH admitted to the Neurology Clinic within 24 hours ofonset. Forty seven patients underwent surgical evacuation and the remaining 47 received conservative medical therapy. Neurological deficit and clinical outcome were assessed by Glasgow Coma Scale (GCS), National Institutes of Health Stroke Scale (NIHSS) and Glasgow Outcome Scale (GOS). Each patient was assessed on two occasions, the first on admission and the second after one month. The statistical analysis was performed with the Statistical Package for Social Sciences, version 13.0 (SPSS). Result(s): Neurological deficit, hematoma volume and location displayed correlation with GOS in the conservative group (p>0.05), while no statistical significance between GOS and hematoma volume in the surgical group (p<0.05) was observed. Surgically treated patients with a baseline GCS>12 had a better final GOS relative to conservatively treated ones. There was no statistically significant difference in GOS on the 30th day of treatment for both groups. The mortality of 4.3% was significantly lower in the surgical group (p<0.05). Conclusion(s): Early surgery for sICH might be a safe and effective treatment, especially for large hematomas (>60cc) in male patients with progressive impairment of consciousness.Copyright © 2019, Peytchinski, Gospodin Iliev ET. All rights reserved.