title: Spontaneous supratentorial intracerebral hemorrhage: Does surgery benefit comatose patients?
abstract: BACKGROUND
  Treatment of spontaneous supratentorial intracerebral hemorrhage (SICH) is still controversial. We therefore analyzed the comatose patients diagnosed as having spontaneous SICH and treated by surgery.
  
  
  METHODS
  We retrospectively analyzed the collected data of 25 comatose patients with initial Glasgow Coma Scale (GCS) ≤ 8 diagnosed as having spontaneous SICH and they had been treated by surgical evacuation between 1996 and 2008. The outcome was assessed using Glasgow outcome scale (GOS). The side and location of the hematoma and ventricular extension of the hematoma were recorded. The hematoma volume was graded as mild (<30 cc), moderate (30-60 cc) and massive (>60 cc).
  
  
  RESULTS
  Age of the patients ranged from 25 to 78 years (mean: 59.6 ± 15.14 years). Among the 25 patients studied, 11 (44%) were females and 14 (56%) were males. GCS before surgery was <5 in 8 (32%) patients and between 5 and 8 in 17 (68%) patients. The hematoma volume was less than 30 cc in 2 patients, between 30 and 60 cc in 9 patients and more than 60 cc in 14 patients. Fourteen of the patients had no ventricular connection and 11 of the hematomas were connected to ventricle. All the 25 patients were treated with craniotomy and evacuation of the hematoma was done within an average of 2 hours on admission to the emergency department. Postoperatively, no rebleeding occurred in our patients. The most important complication was infection in 14 of the patients. The mortality of our surgical series was 56%. GCS before surgery was one of the strongest factors affecting outcome GCS (oGCS) (P = 0.017). Income GCS (iGCS), however, did not affect GOS (P = 0.64). The volume of the hematoma also affected the outcome (P = 0.037). Ventricular extension of the hematoma did affect the oGCS and GOS (P = 0.002), but not the iGCS of the patients (P = 0.139).
  
  
  CONCLUSIONS
  Our data suggest that being surgically oriented is very important to achieve successful outcomes in a select group of patients with SICH.
authors.affiliation: Department of Neurosurgery, Baskent University, Ankara, Turkey.
authors.forename: Cem
authors.initials: C
authors.lastname: Yilmaz
authors.forename: Serdar
authors.initials: S
authors.lastname: Kabatas
authors.forename: Salih
authors.initials: S
authors.lastname: Gulsen
authors.forename: Tufan
authors.initials: T
authors.lastname: Cansever
authors.forename: Doga
authors.initials: D
authors.lastname: Gurkanlar
authors.forename: Hakan
authors.initials: H
authors.lastname: Caner
authors.forename: Nur
authors.initials: N
authors.lastname: Altinors