Surgery for patients with severe supratentorial intracerebral hemorrhage.
BACKGROUND
Little information is available on the efficacy of aggressive treatment such as surgery in improving the outcome of severely affected patients after supratentorial intracerebral hemorrhage (ICH). Our objective was to assess the effect of hematoma removal and ventricular drainage on the mortality of patients with severe primary supratentorial ICH.


METHODS
We studied 103 consecutive patients who were admitted to the intensive care unit and diagnosed with primary supratentorial ICH. The impacts of clinical factors on 30-day mortality were assessed, including surgery, Glasgow Coma Scale (GCS) score and pupillary abnormality at admission, hematoma volume, and other related factors.


RESULTS
The 30-day mortality rate was 42%, and the median time between admission and death was 3 days (range: 1 to 27 days). Hematoma removal and ventricular drainage, within the first 24 hours of admission, were performed on 11 and 17 patients, respectively. Two patients who were treated with removal and four with drainage died. A logistic regression model for predicting 30-day mortality was performed. After controlling for GCS score, pupillary abnormality, hydrocephalus, and hematoma volume, hematoma removal was identified as an independent predictor of survival (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.02 to 0.92). Ventricular drainage also tended to decrease mortality rate greatly (OR, 0.31; 95% CI, 0.06 to 1.76). Patients with GCS scores of 3 or 4 were 4.01 times more likely to die (95% CI, 1.13 to 14.26) than those with GCS of at least 5.


CONCLUSIONS
Hematoma removal may reduce the mortality rate of patients with severe supratentorial ICH.
Ohwaki
Kazuhiro
K
Department of Hygiene and Public Health, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi, Tokyo, Japan. ns-waki@med.teikyo-u.ac.jp
Yano
Eiji
E
Nagashima
Hiroshi
H
Hirata
Masafumi
M
Nakagomi
Tadayoshi
T
Tamura
Akira
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D001930:Brain Injuries / Q000150:complications / Q000401:mortality / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000401:mortality / Q000601:surgery; D002552:Cerebral Ventricles / Q000601:surgery; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D011379:Prognosis; D011681:Pupil Disorders / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013396:Suction; D015996:Survival Rate; D014057:Tomography, X-Ray Computed