title: Postoperative outcome of cerebral amyloid angiopathy-related lobar intracerebral hemorrhage:  case series and systematic review.
abstract: BACKGROUND
  Despite its accessible superficial location, the indication for surgical evacuation in cases of lobar intracerebral hemorrhage (LICH) suspected to be related to cerebral amyloid angiopathy (CAA) is controversial because of advanced patient age and concerns about postoperative hemostasis.
  
  
  OBJECTIVE
  To examine factors associated with postoperative outcome in CAA-related LICH.
  
  
  METHODS
  Review of consecutive patients with pathologically proven CAA who underwent LICH evacuation at Saint Marys Hospital, Rochester, Minnesota, between 1987 and 2006. End points were length of stay and postoperative outcome at discharge and last follow-up using the Glasgow Outcome Scale. We also performed a systematic review of all published studies evaluating the outcome of surgically treated CCA-related LICH published between 1984 and 2010.
  
  
  RESULTS
  We identified 23 patients with CAA-related LICH treated surgically. Favorable outcome (Glasgow Outcome Scale >3) at discharge was noted in 5 patients (22%), and at 6- to 12-month follow-up (n = 15) in 7 patients (47%). Three (13%) died in the hospital, including 1 of 4 patients with postoperative hemorrhage. Intraventricular hemorrhage (IVH) was associated with poor outcome at discharge. Older age (≥75 years), history of hypertension, and degree of preoperative midline shift were associated with more prolonged length of stay. In our systematic review, we identified 14 studies including 278 cases. Overall mortality rate was 25%, and poor postoperative outcome was associated with older age, IVH, and preoperative dementia.
  
  
  CONCLUSIONS
  Neurosurgical evacuation may be performed with acceptable safety in patients with CAA-related LICH. A systematic literature review indicates that older age, preexistent dementia, and presurgical IVH portend poor postoperative outcome.
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.forename: Xin
authors.initials: X
authors.lastname: Wang
authors.forename: Caleb
authors.initials: C
authors.lastname: Schultz
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
mesh_terms: D000328:Adult; D000368:Aged; D016657:Cerebral Amyloid Angiopathy / Q000150:complications*; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000628:therapy*; D013997:Time Factors