DOI: http://dx.doi.org/10.18203/2349-2902.isj20212702

Management of spontaneous intra parenchymal hematomas: a cohort study

Girish K. Madhavan, Philip Issac, Balakrishnan P. Kunjan, Ajax John, Tom Jose

Abstract


Background: Management of intra parenchymal hematoma is a dilemma for neuroscientists, still a life-threatening entity which needs multidisciplinary approach.13% of all strokes constitutes hemorrhagic. Mortality and morbidity of patients depends on the status of initial presentation. Prognosis of the surgeries may vary from person to person and according to the comorbidities. The aim of the study was to determine effectiveness of decompressive craniectomy (DC) with hematoma evacuation in reducing the mortality.

Methods: Patients with spontaneous intra parenchymal hematomas were selected and those having herniation syndrome were considered for surgery. Patients were evaluated after 30 days and 6 months and mortality was calculated.

Results: 126 patients were selected for surgery, in that 102 patients underwent DC with hematoma evacuation and 24 patients who were not willing for surgery were considered as control group. Mortality of patients at 30 days of surgical group was 19.6% and 58.3% respectively, while 6 months mortality was 31.3% and 70.8% for surgical and control group.

Conclusions: Surgical intervention can effectively reduce the mortality in spontaneous intra parenchymal hematomas.

Keywords


Decompressive craniectomy, Intraparenchymal hemtoma, Hematoma evacuation

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References


Vahedi K, Hofmeijer J, Juettler E, Vicaut E, George B, Algra A, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol. 2007;6(3):215-22.

Weiner GM, Lacey MR, Mackenzie L, Shah DP, Frangos SG, Grady MS, et al. Decompressive craniectomy for elevated intracranial pressure and its effect on the cumulative ischemic burden and therapeutic intensity levels after severe traumatic brain injury. Neurosurgery. 2010;66(6):1111-8.

Nagel A, Graetz D, Vajkoczy P, Sarrafzadeh AS. Decompressive craniectomy in aneurysmal subarachnoid hemorrhage: relation to cerebral perfusion pressure and metabolism. Neurocrit Care. 2009;11(3):384-94.

Ferro JM, Crassard I, Coutinho JM, Canhao P, Barinagarrementeria F, Cucchiara B, Derex L, et al. Decompressive surgery in cerebrovenous thrombosis: a multicenter registry and a systematic review of individual patient data. Stroke. 2011;42(10):2825-31.

Ma L, Liu WG, Sheng HS, Fan J, Hu WW, Chen JS. Decompressive craniectomy in addition to hematoma evacuation improves mortality of patients with spontaneous basal ganglia hemorrhage. J Stroke Cerebrovasc Dis. 2010;19(4):294-8.

Shimamura N, Munakata A, Naraoka M, Nakano T, Ohkuma H. Decompressive hemi-craniectomy is not necessary to rescue supratentorial hypertensive intracerebral hemorrhage patients: consecutive single-center experience. Acta Neurochir Suppl. 2011;111:415-9.

Dierssen G, Carda R, Coca JM. The influence of large decompressive craniectomy on the outcome of surgical treatment in spontaneous intracerebral haematomas. Acta Neurochir. 1983;69(1):53-60.

Murthy JM, Chowdary GV, Murthy TV, Bhasha PS, Naryanan TJ. Decompressive craniectomy with clot evacuation in large hemispheric hypertensive intracerebral hemorrhage. Neurocrit Care. 2005;2(3):258-62.

Kim KT, Park JK, Kang SG, Cho KS, Yoo DS, Jang DK, et al. Comparison of the effect of decompressive craniectomy on different neurosurgical diseases. Acta Neurochir. 2009;151(1):21-30.

Ramnarayan R, Anto D, Anilkumar TV, Nayar R. Decompressive hemicraniectomy in large putaminal hematomas: an Indian experience. J Stroke Cerebrovasc Dis. 2009;18(1):1-10.

Broderick JP. The STICH trial: what does it tell us and where do we go from here?. Stroke. 2005;36(7):1619-20.

Bhatia R, Singh H, Singh S, Padma MV, Prasad K, Tripathi M, et al. A prospective study of in-hospital mortality and discharge outcome in spontaneous intracerebral hemorrhage. Neurol India. 2013;61(3):244-8.

Fogelholm R, Murros K, Rissanen A, Avikainen S. Long term survival after primary intracerebral haemorrhage: a retrospective population based study. J Neurol Neurosurg Psychiatry. 2005;76(11):1534-8.

Douglas MA, Haerer AF. Long-term prognosis of hypertensive intracerebral hemorrhage. Stroke. 1982;13(4):488-91.

Flaherty ML, Beck J. Surgery for intracerebral hemorrhage: moving forward or making circles? Stroke. 2013;44(10):2953-4.