title: Surgery versus Conservative Treatment for Spontaneous Supratentorial Intracerebral Hemorrhage in Spot Sign Positive Patients.
abstract: OBJECTIVE
  An advantage of surgical treatment over conservative treatment of spontaneous intracerebral hemorrhage (ICH) is controversial. Recent reports suggest that contrast extravasations on CT angiography (CTA) might serve as a crucial predictor of hematoma expansion and mortality. The purpose of this study was aimed at investigating the efficacy of surgical treatment in patients with spot sign positive ICH.
  
  
  METHODS
  We used our institutional medical data search system to identify all adult patients who admitted for treatment of ICH between January 1, 2007 and January 31, 2012. Patients were classified two groups into a surgical group (n=27) and a conservative treatment group (n=28). Admission criteria were the following: age 20-79 years, spontaneous supratentorial ICH, Glasgow Coma Score Ranging from 9 to 14, ICH volume ≥20 mL, and treatment within 24 hours.
  
  
  RESULTS
  Fifty-five patients were analyzed. There was no significant difference in the ICU stay between the conservative treatment group (7.36±3.66 days) and the surgical treatment group (6.93±2.20 days; p=0.950). There was a significant difference in the in-hospital stay between the conservative treatment group (13.93±8.87 days) and the surgical treatment group (20.33±6.37 days; p=0.001). Overall mortality at day 90 after ICH was 36.4%; this included 16 of 28 patients (57.1%) in the conservative group and 4 of 27 patients (14.8%) in the surgical group. In univariate analysis, there was a positive effect of the surgical treatment in reducing mortality at 90 days (p=0.002), Glasgow Outcome Scale (GOS) at 90-day (p=0.006), and modified Rankin Scale (mRS) at 90-day (p=0.023). In multivariate logistic analysis, there was a significant difference in mortality (odds ratio, 0.211; 95% confidence interval, 0.049-0.906; p=0.036) between the groups at 90-day follow-up. However, there was no significant difference in GOS (odds ratio, 0.371; 95% confidence interval, 0.031-4.446; p=0.434) and mRS (odds ratio, 1.041; 95% confidence interval, 0.086-12.637; p=0.975) between the groups at 90-day follow-up.
  
  
  CONCLUSIONS
  In this study of surgical treatment of supratentorial ICH in patients with spot sign positive in CTA was associated with less mortality despite of long duration of in-hospital stay. We failed to show that clinical outcome benefit of surgical treatment compared with conservative treatment in patients with spot sign positive ICH.
authors.affiliation: Department of Neurosurgery, Chonbuk National University Hospital and Medical School, Jeonju, Korea.
authors.forename: Hui-Tae
authors.initials: HT
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Chonbuk National University Hospital and Medical School, Jeonju, Korea.
authors.forename: Jong-Myong
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Chonbuk National University Hospital and Medical School, Jeonju, Korea.
authors.forename: Eun-Jeong
authors.initials: EJ
authors.lastname: Koh
authors.affiliation: Department of Neurosurgery, Chonbuk National University Hospital and Medical School, Jeonju, Korea.
authors.forename: Ha-Young
authors.initials: HY
authors.lastname: Choi
keywords: Conservative treatment; Intracerebral hemorrhage; Spot sign; Surgery