Background: Spontaneous, nontraumatic intracerebral hemorrhage (ICH) remains a significant cause
of morbidity and mortality throughout the world. Although ICH has traditionally lagged behind
ischemic stroke and aneurysmal subarachnoid hemorrhage in terms of evidence from clinical trials to
guide management, the past decade has seen a dramatic increase in studies of ICH intervention. The
aim of the present study was to evaluate the survival and functional outcome after surgical evacuation
of spontaneous supratentorial intra cerebral hemorrhage and factors affecting prognosis. Methods:
This is a prospective study for 50 consecutive patients admitted to neurosurgery department in Benha
university Hospital suffering from spontaneous intra cerebral hemorrhage (ICH) in ER where
examination was done including the general examination, neurological and other systems. Initial CT
brain scan was done on admission by evaluation of size of hematoma, site , midline shift , presence of
intra ventricular extention. Results: According to Mortality rate, 10 (20%) patients died within
average of 7.5 days after surgery ranged between 0 to 13 days . their initial GCS before surgery was
5 in four cases and 6 in 6 cases which worsen after surgery. Survived cases needed average of 2.92±
1.03 days to be fully conscious ranged between 2 to 5 days. mRS distribution in all studied group
after 6 months of surgery was varied between 0 to 6 as 0 grade means no residual symptoms in 2
(4%) patient while 4 (8%) patients showed grade 1 no significant disability, 10 (20%) patients
showed grade 2 slight disability, 20 (40%) patients showed grade 3 moderate disability and 10 (20%)
showed grade 6 which means dead cases. There was statistically significant difference between Mean
GCS before and after surgery (p = < .0001) as it was 9.04 and improved to 11.56 before leaving
hospital. The mean mRS after surgery and before leaving the hospital was 3.72 ± 0.91 ranged
between 1 to 5 while after 6 months the mean improved to 3.2 after 6 months with a statistically
significant difference (p = 0.0013). Conclusion: Craniotomy and evacuation of spontaneous
supratentorial ICH in patients with good premorbid status and moderate to good GCS even with big
sized hematoma (more than 50 ml) have better long-term functional outcome. A combination of
surgery and neurocritical care can result in favorable clinical outcome, regardless of ICH size or
location. |
