BACKGROUND: A modest benefit was previously demonstrated for hematoma evacuation within 12 hours of intracerebral hemorrhage onset. Perhaps surgery within 4 hours would further improve outcome. METHODS: Adult patients with spontaneous supratentorial intracerebral hemorrhage were prospectively enrolled. Craniotomy and clot evacuation were commenced within 4 hours of symptom onset in all cases. Mortality and functional outcome were assessed at 6 months. This group of patients was compared with patients treated within 12 hours of symptom onset using the same surgical and medical protocols. RESULTS: The study was stopped after a planned interim analysis of 11 patients in the 4-hour surgery arm. Median time to surgery was 180 minutes; median hematoma volume was 40 mL; median baseline NIH Stroke Scale score was 19 and Glasgow Coma Scale score was 12. Six-month mortality was 36% and median Barthel score was 75 in survivors. Postoperative rebleeding occurred in four patients, three of whom died. A relationship between postoperative rebleeding and mortality was apparent (p = 0.03). Rebleeding occurred in 40% of the patients treated within 4 hours, compared with 12% of the patients treated within 12 hours (p = 0.11). There was a clear correlation between improved outcome and smaller postsurgical hematoma volume (p = 0.04). CONCLUSIONS: Surgical hematoma evacuation within 4 hours of symptom onset is complicated by rebleeding, indicating difficulty with hemostasis. Maximum removal of blood remains a predictor of good outcome.
BACKGROUND: A modest benefit was previously demonstrated for hematoma evacuation within 12 hours of intracerebral hemorrhage onset. Perhaps surgery within 4 hours would further improve outcome. METHODS: Adult patients with spontaneous supratentorial intracerebral hemorrhage were prospectively enrolled. Craniotomy and clot evacuation were commenced within 4 hours of symptom onset in all cases. Mortality and functional outcome were assessed at 6 months. This group of patients was compared with patients treated within 12 hours of symptom onset using the same surgical and medical protocols. RESULTS: The study was stopped after a planned interim analysis of 11 patients in the 4-hour surgery arm. Median time to surgery was 180 minutes; median hematoma volume was 40 mL; median baseline NIH Stroke Scale score was 19 and Glasgow Coma Scale score was 12. Six-month mortality was 36% and median Barthel score was 75 in survivors. Postoperative rebleeding occurred in four patients, three of whom died. A relationship between postoperative rebleeding and mortality was apparent (p = 0.03). Rebleeding occurred in 40% of the patients treated within 4 hours, compared with 12% of the patients treated within 12 hours (p = 0.11). There was a clear correlation between improved outcome and smaller postsurgical hematoma volume (p = 0.04). CONCLUSIONS: Surgical hematoma evacuation within 4 hours of symptom onset is complicated by rebleeding, indicating difficulty with hemostasis. Maximum removal of blood remains a predictor of good outcome.
Authors: Paul Vespa; David McArthur; Chad Miller; Kristine O'Phelan; John Frazee; Chelsea Kidwell; Jeffery Saver; Sidney Starkman; Neil Martin Journal: Neurocrit Care Date: 2005 Impact factor: 3.210
Authors: Maged D Fam; Daniel Hanley; Agnieszka Stadnik; Hussein A Zeineddine; Romuald Girard; Michael Jesselson; Ying Cao; Lynn Money; Nichol McBee; Amanda J Bistran-Hall; W Andrew Mould; Karen Lane; Paul J Camarata; Mario Zuccarello; Issam A Awad Journal: Neurosurgery Date: 2017-11-01 Impact factor: 4.654
Authors: Ryan J Barrett; Rahat Hussain; William M Coplin; Samera Berry; Penelope M Keyl; Daniel F Hanley; Robert R Johnson; J Ricardo Carhuapoma Journal: Neurocrit Care Date: 2005 Impact factor: 3.210
Authors: Jizong Zhao; Liangfu Zhou; Dingbiao Zhou; Renzhi Wang; Mei Wang; Dejiang Wang; Shuo Wang; Ge Yuan; Shuai Kang; Nan Ji; Yuanli Zhao; Xun Ye Journal: Front Med China Date: 2007-02-01