Surgical evacuation of cerebral intraparenchymal hemorrhage: prognostic factors and outcome: a retrospective study

Abstract

BACKGROUND: Cerebral intraparenchymal hemorrhage (CIPH) is a major cause of morbidity and mortality worldwide. Despite its detrimental prognosis, treatment options are few and have remained invariable over the last years. Many studies have been conducted worldwide in order to establish the role of evacuating surgery as a potential treatment, but they all failed to provide significant evidence of its benefits. Nevertheless, subgroup analysis of these studies suggest certain patients would benefit from it. More studies are necessary in order to clarify this controversy. PURPOSE: the aim of this study is to describe the outcome of evacuating surgeries for CIPH at our center, and to find some variables that might be associated to a better prognosis of these patients. METHODS: In a descriptive, retrospective cohort study we analysed the medical history of all patients with CIPH who underwent evacuating surgery in Doctor Josep Trueta Hospital (JTH) in 10 years (from january 2009 to December 2018). Descriptive, bivariate and multivariate analysis were performed in order to assess the association between certain variables and the functional outcome and mortality of these patients. RESULTS: a total of 43 patients were studied, with a mean age of 59,91± 12,8. 58,1% were women. 67,4% had AHT and 18,6% were OAC or antiplatelet consumers. The median NIHSS was 18 [13,21] and the median volume was 50 [36,77]. The most frequent cause of CIPH in our series was arterial hypertension (AHT), followed by arteriovenous malformations (AVM). 3 months after the surgical intervention, 16 (37,2%) patients had died and 40 (93%) patients presented a poor outcome. 35 (81,4%) patients were functionally dependent 1 year after surgery. Neither the volume of the hematoma nor the time to surgery were significant independent predictors of the outcome of those patients. CONCLUSION: Mortality stood at 37,2%, and 81,4% of patients were dependent at 1 year of the surgery. Our study did not find any factor associated to a worse outcome on patients operated from evacuation of a CIPH in JTH. Mortality rates in our sample were not different from those reported in previous studies