Joji B Kuramatsu1, Alessandro Biffi2,3, Stefan T Gerner1, Jochen A Sembill1, Maximilian I Sprügel1, Audrey Leasure4, Lauren Sansing4, Charles Matouk4, Guido J Falcone4, Matthias Endres5,6,7,8, Karl Georg Haeusler5,6,9, Jan Sobesky5,6, Johannes Schurig6, Sarah Zweynert5, Miriam Bauer6, Peter Vajkoczy10, Peter A Ringleb11, Jan Purrucker11, Timolaos Rizos11,12, Jens Volkmann9, Wolfgang Müllges9, Peter Kraft9, Anna-Lena Schubert9, Frank Erbguth13, Martin Nueckel13, Peter D Schellinger14, Jörg Glahn14, Ulrich J Knappe15, Gereon R Fink16, Christian Dohmen16, Henning Stetefeld16, Anna Lena Fisse17, Jens Minnerup17, Georg Hagemann18, Florian Rakers18, Heinz Reichmann19, Hauke Schneider19,20, Jan Rahmig19, Albert Christian Ludolph21, Sebastian Stösser21, Hermann Neugebauer9,21, Joachim Röther22, Peter Michels22, Michael Schwarz23, Gernot Reimann23, Hansjörg Bäzner24, Henning Schwert24, Joseph Claßen25, Dominik Michalski25, Armin Grau26, Frederick Palm26, Christian Urbanek26, Johannes C Wöhrle27, Fahid Alshammari27, Markus Horn28, Dirk Bahner28, Otto W Witte29, Albrecht Günther29, Gerhard F Hamann30, Manuel Hagen1, Sebastian S Roeder1, Hannes Lücking31, Arnd Dörfler31, Fernando D Testai32, Daniel Woo33, Stefan Schwab1, Kevin N Sheth4, Hagen B Huttner1. 1. Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany. 2. Department of Neurology, Massachusetts General Hospital, Boston. 3. Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Boston, Massachusetts. 4. Department of Neurology, Yale University School of Medicine, New Haven, Connecticut. 5. Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany. 6. Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany. 7. German Centre for Cardiovascular Research (DZHK), Berlin, Germany. 8. German Center for Neurodegenerative Diseases (DZNE), partner site Berlin, Berlin, Germany. 9. Department of Neurology, University of Würzburg, Würzburg, Germany. 10. Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany. 11. Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany. 12. Department of Neurology, Alfried Krupp Krankenhaus Essen, Essen, Germany. 13. Department of Neurology, Community Hospital Nuremberg, Nuremberg, Germany. 14. Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center Minden, UK RUB, Minden, Germany. 15. Department of Neurosurgery, Johannes Wesling Medical Center Minden, UK RUB, Minden, Germany. 16. Department of Neurology, University of Cologne, Cologne, Germany. 17. Department of Neurology, University of Münster, Münster, Germany. 18. Department of Neurology, Community Hospital Helios Klinikum Berlin-Buch, Berlin, Germany. 19. Department of Neurology, University of Dresden, Dresden, Germany. 20. Department of Neurology, Klinikum Augsburg, Augsburg, Germany. 21. Department of Neurology, University of Ulm, Ulm, Germany. 22. Department of Neurology, Community Hospital Asklepios Klinik Hamburg Altona, Hamburg, Germany. 23. Department of Neurology, Community Hospital Klinikum Dortmund, Dortmund, Germany. 24. Department of Neurology, Community Hospital Klinikum Stuttgart, Stuttgart, Germany. 25. Department of Neurology, University of Leipzig, Leipzig, Germany. 26. Department of Neurology, Community Hospital Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen, Germany. 27. Department of Neurology, Community Hospital Klinikum Koblenz, Koblenz, Germany. 28. Department of Neurology, Community Hospital Bad Hersfeld, Bad Hersfeld, Germany. 29. Department of Neurology, University of Jena, Jena, Germany. 30. Department of Neurology and Neurological Rehabilitation, Bezirkskrankenhaus Günzburg, Günzburg, Germany. 31. Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany. 32. Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago. 33. Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio.
Abstract
Importance: The association of surgical hematoma evacuation with clinical outcomes in patients with cerebellar intracerebral hemorrhage (ICH) has not been established. Objective: To determine the association of surgical hematoma evacuation with clinical outcomes in cerebellar ICH. Design, Setting, and Participants: Individual participant data (IPD) meta-analysis of 4 observational ICH studies incorporating 6580 patients treated at 64 hospitals across the United States and Germany (2006-2015). Exposure: Surgical hematoma evacuation vs conservative treatment. Main Outcomes and Measures: The primary outcome was functional disability evaluated by the modified Rankin Scale ([mRS] score range: 0, no functional deficit to 6, death) at 3 months; favorable (mRS, 0-3) vs unfavorable (mRS, 4-6). Secondary outcomes included survival at 3 months and at 12 months. Analyses included propensity score matching and covariate adjustment, and predicted probabilities were used to identify treatment-related cutoff values for cerebellar ICH. Results: Among 578 patients with cerebellar ICH, propensity score-matched groups included 152 patients with surgical hematoma evacuation vs 152 patients with conservative treatment (age, 68.9 vs 69.2 years; men, 55.9% vs 51.3%; prior anticoagulation, 60.5% vs 63.8%; and median ICH volume, 20.5 cm3 vs 18.8 cm3). After adjustment, surgical hematoma evacuation vs conservative treatment was not significantly associated with likelihood of better functional disability at 3 months (30.9% vs 35.5%; adjusted odds ratio [AOR], 0.94 [95% CI, 0.81 to 1.09], P = .43; adjusted risk difference [ARD], -3.7% [95% CI, -8.7% to 1.2%]) but was significantly associated with greater probability of survival at 3 months (78.3% vs 61.2%; AOR, 1.25 [95% CI, 1.07 to 1.45], P = .005; ARD, 18.5% [95% CI, 13.8% to 23.2%]) and at 12 months (71.7% vs 57.2%; AOR, 1.21 [95% CI, 1.03 to 1.42], P = .02; ARD, 17.0% [95% CI, 11.5% to 22.6%]). A volume range of 12 to 15 cm3 was identified; below this level, surgical hematoma evacuation was associated with lower likelihood of favorable functional outcome (volume ≤12 cm3, 30.6% vs 62.3% [P = .003]; ARD, -34.7% [-38.8% to -30.6%]; P value for interaction, .01), and above, it was associated with greater likelihood of survival (volume ≥15 cm3, 74.5% vs 45.1% [P < .001]; ARD, 28.2% [95% CI, 24.6% to 31.8%]; P value for interaction, .02). Conclusions and Relevance: Among patients with cerebellar ICH, surgical hematoma evacuation, compared with conservative treatment, was not associated with improved functional outcome. Given the null primary outcome, investigation is necessary to establish whether there are differing associations based on hematoma volume.
Importance: The association of surgical hematoma evacuation with clinical outcomes in patients with cerebellar intracerebral hemorrhage (ICH) has not been established. Objective: To determine the association of surgical hematoma evacuation with clinical outcomes in cerebellar ICH. Design, Setting, and Participants: Individual participant data (IPD) meta-analysis of 4 observational ICH studies incorporating 6580 patients treated at 64 hospitals across the United States and Germany (2006-2015). Exposure: Surgical hematoma evacuation vs conservative treatment. Main Outcomes and Measures: The primary outcome was functional disability evaluated by the modified Rankin Scale ([mRS] score range: 0, no functional deficit to 6, death) at 3 months; favorable (mRS, 0-3) vs unfavorable (mRS, 4-6). Secondary outcomes included survival at 3 months and at 12 months. Analyses included propensity score matching and covariate adjustment, and predicted probabilities were used to identify treatment-related cutoff values for cerebellar ICH. Results: Among 578 patients with cerebellar ICH, propensity score-matched groups included 152 patients with surgical hematoma evacuation vs 152 patients with conservative treatment (age, 68.9 vs 69.2 years; men, 55.9% vs 51.3%; prior anticoagulation, 60.5% vs 63.8%; and median ICH volume, 20.5 cm3 vs 18.8 cm3). After adjustment, surgical hematoma evacuation vs conservative treatment was not significantly associated with likelihood of better functional disability at 3 months (30.9% vs 35.5%; adjusted odds ratio [AOR], 0.94 [95% CI, 0.81 to 1.09], P = .43; adjusted risk difference [ARD], -3.7% [95% CI, -8.7% to 1.2%]) but was significantly associated with greater probability of survival at 3 months (78.3% vs 61.2%; AOR, 1.25 [95% CI, 1.07 to 1.45], P = .005; ARD, 18.5% [95% CI, 13.8% to 23.2%]) and at 12 months (71.7% vs 57.2%; AOR, 1.21 [95% CI, 1.03 to 1.42], P = .02; ARD, 17.0% [95% CI, 11.5% to 22.6%]). A volume range of 12 to 15 cm3 was identified; below this level, surgical hematoma evacuation was associated with lower likelihood of favorable functional outcome (volume ≤12 cm3, 30.6% vs 62.3% [P = .003]; ARD, -34.7% [-38.8% to -30.6%]; P value for interaction, .01), and above, it was associated with greater likelihood of survival (volume ≥15 cm3, 74.5% vs 45.1% [P < .001]; ARD, 28.2% [95% CI, 24.6% to 31.8%]; P value for interaction, .02). Conclusions and Relevance: Among patients with cerebellar ICH, surgical hematoma evacuation, compared with conservative treatment, was not associated with improved functional outcome. Given the null primary outcome, investigation is necessary to establish whether there are differing associations based on hematoma volume.
Authors: Daniel F Hanley; Karen Lane; Nichol McBee; Wendy Ziai; Stanley Tuhrim; Kennedy R Lees; Jesse Dawson; Dheeraj Gandhi; Natalie Ullman; W Andrew Mould; Steven W Mayo; A David Mendelow; Barbara Gregson; Kenneth Butcher; Paul Vespa; David W Wright; Carlos S Kase; J Ricardo Carhuapoma; Penelope M Keyl; Marie Diener-West; John Muschelli; Joshua F Betz; Carol B Thompson; Elizabeth A Sugar; Gayane Yenokyan; Scott Janis; Sayona John; Sagi Harnof; George A Lopez; E Francois Aldrich; Mark R Harrigan; Safdar Ansari; Jack Jallo; Jean-Louis Caron; David LeDoux; Opeolu Adeoye; Mario Zuccarello; Harold P Adams; Michael Rosenblum; Richard E Thompson; Issam A Awad Journal: Lancet Date: 2017-01-10 Impact factor: 79.321
Authors: Daniel Woo; Jonathan Rosand; Chelsea Kidwell; Jacob L McCauley; Jennifer Osborne; Mark W Brown; Sandra E West; Eric W Rademacher; Salina Waddy; Jamie N Roberts; Sebastian Koch; Nicole R Gonzales; Gene Sung; Steven J Kittner; Lee Birnbaum; Michael Frankel; Fernando Daniel Testai; Christiana E Hall; Mitchell S V Elkind; Matthew Flaherty; Bruce Coull; Ji Y Chong; Tanya Warwick; Marc Malkoff; Michael L James; Latisha K Ali; Bradford B Worrall; Floyd Jones; Tiffany Watson; Anne Leonard; Rebecca Martinez; Ralph I Sacco; Carl D Langefeld Journal: Stroke Date: 2013-09-10 Impact factor: 7.914
Authors: J Claude Hemphill; Steven M Greenberg; Craig S Anderson; Kyra Becker; Bernard R Bendok; Mary Cushman; Gordon L Fung; Joshua N Goldstein; R Loch Macdonald; Pamela H Mitchell; Phillip A Scott; Magdy H Selim; Daniel Woo Journal: Stroke Date: 2015-05-28 Impact factor: 7.914
Authors: Maximilian I Sprügel; Joji B Kuramatsu; Stefan T Gerner; Jochen A Sembill; Vanessa D Beuscher; Manuel Hagen; Sebastian S Roeder; Hannes Lücking; Tobias Struffert; Arnd Dörfler; Stefan Schwab; Hagen B Huttner Journal: Stroke Date: 2018-11 Impact factor: 7.914
Authors: Joji B Kuramatsu; Jochen A Sembill; Stefan T Gerner; Maximilian I Sprügel; Manuel Hagen; Sebastian S Roeder; Matthias Endres; Karl Georg Haeusler; Jan Sobesky; Johannes Schurig; Sarah Zweynert; Miriam Bauer; Peter Vajkoczy; Peter A Ringleb; Jan Purrucker; Timolaos Rizos; Jens Volkmann; Wolfgang Müllges; Peter Kraft; Anna-Lena Schubert; Frank Erbguth; Martin Nueckel; Peter D Schellinger; Jörg Glahn; Ulrich J Knappe; Gereon R Fink; Christian Dohmen; Henning Stetefeld; Anna Lena Fisse; Jens Minnerup; Georg Hagemann; Florian Rakers; Heinz Reichmann; Hauke Schneider; Sigrid Wöpking; Albert Christian Ludolph; Sebastian Stösser; Hermann Neugebauer; Joachim Röther; Peter Michels; Michael Schwarz; Gernot Reimann; Hansjörg Bäzner; Henning Schwert; Joseph Claßen; Dominik Michalski; Armin Grau; Frederick Palm; Christian Urbanek; Johannes C Wöhrle; Fahid Alshammari; Markus Horn; Dirk Bahner; Otto W Witte; Albrecht Günther; Gerhard F Hamann; Hannes Lücking; Arnd Dörfler; Stephan Achenbach; Stefan Schwab; Hagen B Huttner Journal: Eur Heart J Date: 2018-05-14 Impact factor: 29.983
Authors: Lisa M Askie; Brian A Darlow; Neil Finer; Barbara Schmidt; Ben Stenson; William Tarnow-Mordi; Peter G Davis; Waldemar A Carlo; Peter Brocklehurst; Lucy C Davies; Abhik Das; Wade Rich; Marie G Gantz; Robin S Roberts; Robin K Whyte; Lorrie Costantini; Christian Poets; Elizabeth Asztalos; Malcolm Battin; Henry L Halliday; Neil Marlow; Win Tin; Andrew King; Edmund Juszczak; Colin J Morley; Lex W Doyle; Val Gebski; Kylie E Hunter; Robert J Simes Journal: JAMA Date: 2018-06-05 Impact factor: 56.272
Authors: Joji B Kuramatsu; Stefan T Gerner; Wendy Ziai; Stefan Schwab; Daniel F Hanley; Hagen B Huttner; Jürgen Bardutzky; Jochen A Sembill; Maximilian I Sprügel; Anne Mrochen; Kathrin Kölbl; Malathi Ram; Radhika Avadhani; Guido J Falcone; Magdy H Selim; Vasileios-Arsenios Lioutas; Matthias Endres; Sarah Zweynert; Peter Vajkoczy; Peter A Ringleb; Jan C Purrucker; Jens Volkmann; Hermann Neugebauer; Frank Erbguth; Peter D Schellinger; Ulrich J Knappe; Gereon R Fink; Christian Dohmen; Jens Minnerup; Heinz Reichmann; Hauke Schneider; Joachim Röther; Gernot Reimann; Michael Schwarz; Hansjörg Bäzner; Joseph Claßen; Dominik Michalski; Otto W Witte; Albrecht Günther; Gerhard F Hamann; Hannes Lücking; Arnd Dörfler; Muhammad Fawad Ishfaq; Jason J Chang; Fernando D Testai; Daniel Woo; Andrei V Alexandrov; Dimitre Staykov; Nitin Goyal; Georgios Tsivgoulis; Kevin N Sheth; Issam A Awad Journal: Stroke Date: 2022-05-06 Impact factor: 10.170
Authors: Jochen A Sembill; Joji B Kuramatsu; Stefan T Gerner; Maximilian I Sprügel; Sebastian S Roeder; Dominik Madžar; Manuel Hagen; Philip Hoelter; Hannes Lücking; Arnd Dörfler; Stefan Schwab; Hagen B Huttner Journal: Ann Clin Transl Neurol Date: 2020-03-04 Impact factor: 4.511
Authors: D Michalski; C Jungk; T Brenner; M Dietrich; C Nusshag; C J Reuß; M O Fiedler; M Bernhard; C Beynon; M A Weigand Journal: Anaesthesist Date: 2021-02 Impact factor: 1.041